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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> T j <br /> APPLICATION FOR LAND USE PERMITS <br /> a _ S <br /> OWNER - TELEPHONE tyr�2 �y2.- 1(p CD <br /> `JC�ti r1. .S M LTA t5t 141 u t 9 z _T� <br /> r. <br /> MAILING ADDRESS IC)Lj' . i 15_� k& L—T..C.R c'_'t�U ) �__CJLNj kk��11.-) <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION , o Q <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ADDITION LJ DECK Pi� GARAGE/ACCESSORY STRUCTURE ✓ �" <br /> BUNKHOUSE ❑ 59.692(IV)GAZEBO LJ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> a <br /> v <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> p 4 <br /> STRUCTURE/ADDITION USE: tJE:� OOF 'TRJ SSE-S AIEYJ RoDr-r-JLa) 51D.I0jG2 +Tb ILC+I <br /> (Home abin Commercial Business; Bedroom;(Dec ; etc.) <br /> BUILDING CONTRACTOR: 5ZF <br /> r <br /> T S <br /> A PLOT PIAN MUST BE PROVIDED ON AN 8 e/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O <br /> WILL BE RETURNED. <br /> 4 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 'M <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 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, c <br /> AND INDICATE NORTH (N). ,\ _ <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TD THE ORDINARY HIGH WATER MARK <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. 5_ 'm <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. n, <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. ! I� <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: <br /> F n <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERM[1. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. z z <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. ',V_ <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT T E USED FOR HUMAN HABITATION. <br /> 6. �a a/fi. t/�n ti 17a eKceed so% ✓ ,L a /car/ i/aG <br /> lr. ,-' ag <br /> aa � � eam <br /> x Iz a s s 7 <br /> I declare that this applicationIscru ,correct <br /> any accomcomplete. <br /> I ac schedule)has been examinedresponsible <br /> of r t and to the best of urmy a <br /> knowledge and belief tt Is true,mrrect and�rmplete. I acknowledge that(am responsible for the detail and accuracy of as <br /> Information contabmed In this appli atbn(Including any accompanying schedule)and I further declare that I recognize that this <br /> Information I am providing will be relied upon by the County of Butnett Wleconsin b determinig whether to Issue a permit. i b <br /> further accept all liability that may be a repult of the County of Bumett relylrg on this information I am providing In this <br /> application. i agree to Permit county o8klats charged with administrating county ordinances or other authored person to have F. <br /> access to the above-described promises at anytvasonable time for the purpose of Inspection. <br /> OWNERS SIGNATURE "r'� ' 1- 0t e o n r O <br /> (date) o ° d 6 = 2 <br /> ZONING ADMINISTRATOR _ _ " �Ov-= _ ' c rn <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DAT OF SUANCE ` C7 <br /> � <br /> �✓m�f-a 12�'-I-e✓ y <br />