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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 <br /> OWNER TELEPHONE - c <br /> 4-�ean I)Pa'S Ch <br /> MAILING <br /> 5-�-3/- �a-l/ <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS <br /> TU1u Sh,cn J,} SCatt ry1�� �85�fa. Cd I�hi led 1y <br /> LEGAL DESCRIPTION $eebCflirlil �[(/'(!� •--� z <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ IGARAGE CCESSORY STRUCTUR <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ j <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: 5-1y h2 f <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) ' <br /> BUILDING CONTRACTOR: n h <br /> K <br /> G, <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT 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. c <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEWEl <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). 7 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) P t✓ <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. a� <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES �QJ <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. :: a' <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. i <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE ',rz�' <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 " L� <br /> NEEDED. '(1 <br /> THIS PERMIT IS SUBJECT 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. Cy3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER r t <br /> SETBACK AREA. w <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my o a <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this E E: > G > <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I _ 4 r — : > <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this s <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have — ,^, ° 8 r' <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. <br /> "r1 n c : � -, o3 ➢ <br /> wrn k0i. <br /> OWNER'S SIGNATURE e�.n- �WwJwe.�/ i(A <br /> -f.\ II1l11 (date) ` x Ei F Irl <br /> ZONING <br /> s <br /> ZONING ADMINSSTRATOR <br /> d R 6 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />