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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a , <br /> APPLICATION FOR LAND USE PERMITS y }✓ <br /> 0 <br /> OWNER !��w\ TELEPHONE I - �-( -7Z ❑ <br /> MAILING ADDRESS <br /> 11°11 ki JNesSe; , lA,,l . 5l-(ooI ; <br /> PROPERTY ADDRESSI1 C7a w <br /> 3 19 o\-3�Aef- <br /> C) <br /> LEGAL DESCRIPTION c3 r <br /> Loi 9, �,� yeffo��.t Esfa4er, Sc a r 29, T4o� Rj6w,, OJK/s� <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> vl ro <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ c <br /> STRUCTURE/ADDITION USE: .LerK IZ' K )(o' (Ohoo <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) -9 <br /> BUILDING CONTRACTOR: S IF <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS ? <br /> WILL BE RETURNED. <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m n <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, p <br /> AND INDICATE NORTH (N). O N l c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) -I <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK p 5 I N <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 fv 5 d <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. S m �p <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 /> PIANS MUST BE SIGNED AND DATED BY THE OWNER. "O <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. Lnpp <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r- <br /> 1. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ',A n .z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p K A <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. pm, <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER .p <br /> SETBACK AREA. 8 <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. p <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> n o 0 0 6 t" <br /> 7• F l o rt n m o a <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 5 0 4! R 3 e <br /> knowledge and belle(R is true,correct and complete. I admowledge that 1 am responsible for the detail and accuracy of all m m en a H <br /> Information contained In this application(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 Burnett Wisconsin In determining whether to Issue a pemrc. I .e 5- F w •y <br /> further accept all liability that may be a resuR of the County or Burned relying on this information I am providing In this <br /> application. I agree to permit county officials charged with admmisbetlng county ordinances or other authorized person to have �.°� o o- 88 <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. 9 a d+Z''^ f7 <br /> OWNER'S SIGNATURE z 7. 41414" ,i I D 2- <br /> g �^ ' = JR5 = 2 <br /> (date) a 'ro 5. <br /> ZONING ADMINISTRATOR "' m y y °=0 y o n <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N ti U <br /> ug000g <br />