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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS wf1, <br /> OWNER TELEPHONE / S I � p^i,7 <br /> MAILING ADDRESS a �N <br /> I03S Merc,A,(y Or Sial,( I"P,)I )'hn 51SWO <br /> PROPERTYADDRESS _ <br /> �8L10T nn n l.k_A <br /> LEGAL DESCRIPTION ,�,• <br /> SZy T'+on RISW Lott CSM V4 f38 ( Nt�I,�t3) <br /> TYPE OF PERMITS) SINGLE FAMILY DWELLING ❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(IV)GAZEBO ❑ STAIRS ❑ FILLING/GRADINGG�(�CAMPING UNIT 111 v V <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION Cl COMMERCIAL ACCE3S0 Y STRRUCNRE�O '� �_ c <br /> STRUCTURE/ADDITION USE: - <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) I N <br /> BUILDING CONTRACTOR: W <br /> n <br /> A PWT PLAN MUST BE PROVIDED ON AN 8 Ya X11 SHEET <br /> WILL BE RETURNED. OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o t <br /> 44ryS , <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) An <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW 'a <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). vV <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) Sz) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. As <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIEW (DF),AND ALL DISTANCES Cl <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED., ETCTHE <br /> ., m 1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACT <br /> ORa <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. r,\ <br /> NOTE: BUILDING/STRUCTURE MY BE DONE WHENING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION y <br /> THIS PERMIT ISSUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. mN zZ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER - <br /> SETBACK AREA. a <br /> 6.S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. I <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> f <br /> 7. <br /> annn a <br /> nRA1aa A <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my Z R R <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I been <br /> responsible for the detail and best <br /> of accuracy of all D e <br /> Information contained In this application(Includingan accompanyingschedule)esp i further declare that I `5 a a m v <br /> information I am PD Y recognize that this <br /> Providing will be relied upon by the County of Burned Wisconsin In tletemninin9 whether to Issue a permit. I e R e a^: by <br /> further accept all liability that may be a result of the County of Burnett rel Ic si this Information I am 00 <br /> application. I agree to county providing in this N ro <br /> perrrrlt preml officials a yrha a time for the whh amIstretiD purpose county!inispectlon.cc mer authorized person to have o S 8 8 8 ,.r, <br /> access to the abovo-desalbed <br /> i � sassossy <br /> OWNER'S SIGNATURE <br /> � <br /> ' �/' (date) o" a'o <br /> V <br /> ZONING ADMINISTRATOR r� ria <br /> TOWNSHIP PERMITS MAY BE REQUIRED g. w <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DA OF ISSUANCE O . . . <br /> Pe%f 1"81-o88 <br />