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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator n c <br /> APPLICATION FOR LAND USE PERMITS a �� <br /> a <br /> m y <br /> /� <br /> / o m <br /> OWNER '1 1` III /)l.Lrn 4& S6baski 1 TELEPHONE 0 <br /> (� �i I '� n 00 <br /> MAILING ADDRESS Lh S a f �(-� /�N ��r��6 p� 0 <br /> // // [� <br /> PROPERTYADDRESS 'a 1�0� �{-I.Q, <tl0/1 2� <br /> LEGAL DESCRIPTION <br /> 3 <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION 11STAIRS ❑ o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADI 0 <br /> �CnA1M,P1NNG UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: C7 C1 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS — <br /> WILL BE RETURNED. O� n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 6 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. tnli a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW m �' <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). 1 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) O 'p 0 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK tx a <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 (DF),AND ALL DISTANCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. „� w I O <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 C)G <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 'w <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. v y XJ Z I' O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. RJ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ONLY. Y I^ Q, <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER VC' <br /> SETBACK AREA. `l1"1 <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE <br /> NOT TO BE USED FOR HUMAN HABITATION. E <br /> 6. <br /> 7. <br /> g R� g PA M <br /> 3'0 w' ���'w' <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge a. z ti n : y <br /> and belief It Is true,cortect and complete. I acknowledge that I am responsible for the detail and accuracy of all Informatlon m p w 9 <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information 1 .2 <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all 8 b <br /> liability that may be a result of the County of Burnett relying on this Information I am providing In this application. I agree to m �'^ "'`^ r, <br /> permit county officials charged with administrating county ordinances or other authorized penton to have access to the above- <br /> described premises at any reasonable time Pr the purpose pection. v, <br /> m+� <br /> OWNER'S SIGNATURE <�� �"� / — `hI <br /> (date) g s a s <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE 8 N N o <br /> rn La-4Wr/,0t cked ajo bt-1 aa-- Can-Att chja , -�-<l <br />