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h ro o <br /> Burnett County 7410 County Road Ke No. 1.02, Siren,WI 54872 Offke of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> o --1— <br /> OWNER a / TELEPHONE ^� <br /> �x Z Ant <br /> MAILING ADDRESS G1''^^r, 7 ' � + 11 A ei;'&': dk 90J. I R <br /> 1 <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION ,� / �, � ' <br /> TYPE of PEIkMTT(S): SINGLE-FAMILY OWELLINCA ADDITION E3 DECK Cl GARAGE/ACCESSORY STRUCTURE LJ •-I �' <br /> BUNKHOUSEI'3 59.692(1V)GAZEBO❑ STAIRS❑ FILLING/GRADING❑ CAMPING UNIT❑ , <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMM ERCIAL ACCESSORY STRUCTURE ❑ <br /> q <br /> STRUCTURE/ADDITION USE: . /cIf Z. <br /> '}'^ <br /> (Home/Cabin';�Commercial Business; Bedroom; Dad*; ate.) )L.Y� `� <br /> BUILDING CONTRACTOR: <br /> A PLOT PIAN MUST BE PROVIDED ON AN B Y:X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PWT PLANS <br /> WILL BE RETURNED. ' <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, \ P <br /> AND INDICATE NORTH (N). o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDINGS) <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. t7 1 <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. �• �' r <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. , a <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE (�)L,) a <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. lu <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN .a I� <br /> NEEDED. <br /> 1 <br /> THIS PERMIT 1S SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. r� x <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHOREIAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER r <br /> SETBACK AREA. l� l <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. E <br /> 6. <br /> 7. yyA <br /> Z $ <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my g o � B• � <br /> knowledge and belief It Is true,caret and complete. I admow"a that I am responsible for the detail and accuracy of all, ro <br /> Information contained In this application(Including any accompanying schedule)and I farther declare that I recognize that this ?n i y <br /> Information I am providing will be relied upon by the County of Sumett Wisconsin in detarmining whether to Issue a permit. i IRN ,P —i •v <br /> further accept all liability that may be a result of the County of eumett retying an Mit Mfarmatim I am provldmg In this L'`^M N b <br /> application, I agree to permit county officials charged with administrating county adlnences or other authorized person to . <br /> have access to the above-d pmmises at any reasonable time for the purpose Of Impaction. <br /> OWNERS SIGNATURE g$ TS y <br /> (date) ul 9 [q gQW WWI <br /> 7 <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED F i <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> J6004 g <br />