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Bull 1aG County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> DwNER ^fJ I TELEPHONE <br /> MAILING ADDRESS �� GITSL�ta I S �6euF IIS �" <br /> PROPE0.TYADORESS <br /> II I 11 <br /> LEGAL DESCRIPTION t�eail55 L/ (I <br /> TYOFPELME(S): SINGLE-FAMILY DWELLING ADDITION ❑ DECK Kf GAMGE/ACCESSORY STRUCTURE O V <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO❑ STAIRS❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> b <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITIDN❑ [OMMERCIAL ACCESSORY STRUCTURE❑ a <br /> STRUCTURE/ADDRION USE: — PG ei IC Y-tA ahC o <br /> (Home/Cabin; Commercl I Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: Al �On - <br /> A PLOT RAN MUST BE PROVIDED ON AN B w X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL M RETURNED. <br /> DIRECTIONS FOR ROT PLAN DRAWING: (ARIAL OR TOP VIEW) t� a <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 tye b <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, W <br /> AND INDICATE NORTH (N). N c 4J <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)TO THE ORDINARY HIGH WATER MARK O W <br /> (OHWM)OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND(D) LOT DIMENSIONS. p W <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DMINFIELD(DF), AND ALL DISTANCES B U <br /> TO BUILDINGS,ROADS, LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PUNNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE BANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE g L B <br /> PIANS 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. CC. of <br /> THIS PERMIT 15 SUBJECT TO ALL CONDITIONS LISTED BELOW: r C Y <br /> gg O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. h Z 2 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. F p <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. VU <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <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. <br /> Fx1 'R <br /> I declare Mat MIs applketkm(IMuding any acmmpanI ac sCwdule)Ms Men examined by me am to l a bast of cy 9 . II a <br /> knowledge ant Miler k Ia Orae,cwrett e(Immple[e. I actmpanyin Mat I em ram I further <br /> for tM detail and accuracy wall III <br /> Inmrmation containedproviding <br /> di this ill be rAtlon(IMI Wing any imty of vying ,Wisconsin <br /> ant 1 NrMer dg whether <br /> that I hall azp that this '� 6 ?$ m u <br /> further <br /> accept <br /> I am provlity that <br /> be bled upon 6Y the County M Burnett renal <br /> on In determining I am pr to Issue a permit. I <br /> former accept all I1a611tty that may be a res tM County or Burnett l coo ty Orli saes or o I r a providing In MIS " <br /> apDllGdon. 1 agree[o Perm own[y o1B Is mad wttr edminlsbMing couMY oNinanas or otMr apModrtd penton to Mve ^ <br /> access to Me aoove-de ed p tui t any the time for Me Purpose of Inspection. F B y <br /> OWNERS SIGNATOR R yP O •a2 <br /> (date) sn 5 c <br /> ZONING ADMINISTRATOR __ 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> u <br />