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nurnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> . yam/ f „ If, 1� 1 I 7�/ �[ <br /> CWNER 't —" IG��Q✓`AA ht 66AS(P�PHONE 411 ` a-Q- q <br /> v <br /> MAILING ADDRESS <br /> -/1 <br /> SIO✓ ( /..1 .� / 1 N XWd / Ak S�L( Irl <br /> PROPERTY ADDRESS ``11 `cell' 1`_ '��lf'SUl U y�l �[SLf V! l VI <br /> a a <br /> LEGAL DESCRIPTION -' <br /> TYPE OF PERMIT(S): NGLE-FAMILY DWELLING ADDITION DECK GARAGE/ACCESSORY STRUCTURE ', a <br /> BUNKHOUSE 59.692(1V)GAZEBO STAIRS FILLING/GRADING CAMPING UNIT <br /> COMMERCIAL BUILDING COMMERCIAL ADDITION COMMERCIAL ACCESSORY STRUCTURE <br /> STRUCTURE/ADDITION USE: <br /> ^ z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) j is <br /> BUILDING CONTRACTOR: n <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 A X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. a" <br /> °a <br /> DIRECTIONS FOR PLOT PIAN DRAWING: (ARTAL OR TOP VIEW) m ' <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m '� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE-NORTH.(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (0) BUILDINGS) I Ihr, °� <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK SU m <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D)LOT DIMENSIONS. <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST) AND DRAINFIELD (OF), AND ALL DISTANCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. d <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN ._.t <br /> I <br /> NEEDED. d ,^ <br /> LA <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ! lNl <br /> T � � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n 'z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. a <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER ti <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. j <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 7. > 33n 30 > � � <br /> o = <br /> 1 declare that this application(Including any accompanying sclicduie)has been examined by me and to the best of my <br /> knowledge and belief R Is true,connect and compkae. I admDwkdge that I am responsible for the dated and accuracy of all e. M. a <br /> infomanon contained M this application(Including any accompanying schedule)and I further declare that I recognize that this '-. > > m <br /> Information I am providing will be celled upon by the County of Burnett Wisconsin In determining whether to Issue a permit I ; a w` > <br /> further a all liability that <br /> Capt Icy may be a result o/the County of Burnett relying on this irnfonratJon I am providing In this = 5 <br /> application. I agree to permit county officials clanged with administrating county ordinances or other authorized person to have o 8 8 0 .. <br /> access to the above-described at any rgasonabile time for the purppeopf Inspection. ;,; t <br /> yam > � go88 „y,I <br /> y 6 <br /> OWNER'S SIGNATURE > a <br /> ZONING ADMINISTRATOR <br /> AUG-2 ti 2011 � R <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUAW&NETT COUNTY:) <br /> ZONING5 0 0 5 <br />