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z <br /> o <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER i,/ /� 00 TELEPHONE 0 <br /> 1 C - O(ps� <br /> MAILING ADDRESS <br /> Moa <br /> R I _ I . Q�_ VC 1 , <br /> O l9 d� (,(y.(�IK. V LJ `TO (J <br /> PROPERTY ADDRESS0 <br /> 0 <br /> LEGAL DESCRIPTION 1_01- 10, 81ACK Recta ACW64 — (V 'l x I S6 IN., S W.3( � T'41 N) R,1_7 W � 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 /> s <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ _ <br /> a <br /> STRUCTURE/ADDITION USE: � Q � <br /> ome a n; meraa mess; room; c ;etc.) <br /> BUILDING CONTRACTOR: n <br /> O W� <br /> < <br /> 0 <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 /> 6 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) C O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Cc <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW o 0 <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, C, <br /> AND INDICATE NORTH(N). 10 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) (F) P <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 9J O "fl • <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 ti <br /> TO BUILDINGS, ROADS,LAKE, LOT LINES. 1 <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 /> 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. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: UI <br /> z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. g (J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. C O <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER J <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. O <br /> NOT TO BE USED FOR HUMAN HABITATION. D S <br /> 6. C <br /> 7. 'Do 0 o nab R7 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my o �� El P n3 9 <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(induding any accompanying schedule)and I further dedare that I recognize that this E. D m " <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I d c A > <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing in this ? �.`- N 'roC <br /> application. I agree to permit co icials charged with administrating county ordinances or other authorized person to o r" <br /> have access to the ove-d a pr ise y re ab ime for the purpose of inspection. o F D 8 ' g <br /> ab <br /> OWNER'S SIGNATURE <br /> (date)) <br /> r) !n D' <br /> ^ ^ <br /> i1( date ,• fD °' o m ►� <br /> l l Q. az n <br /> 11MF1AQd cZ <br /> ZONING ADMINISTRATOR n <br /> Tom. 9 F a �c lyt <br /> TOWNSHIP PERMITS MAY BE REQUIRED d N . 0 ' <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE $ <br /> �ulrri( � 4 [ (*Rr jo(Gk-[d uf) touj 101'cw1 COOk_9-/-I1 so00 <br />