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z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g - <br /> APPLICATION FOR LAND USE PERMITS <br /> 6 <br /> OWNERT�" II / / TELEPHONE <br /> MAILING ADDRESS <br /> WE --�YJJ S S3D y ° <br /> VVI <br /> PROPERTY ADDRESS 3 O�O I <br /> y`-Y <br /> LEGAL DESCRIPTION �k�j 3— /- I V. S Or.I n1�I T-wY)�I I _ or ban' <br /> _ <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING h ADDITION N DECK I GARAGE/ACCESSORY STRUCTU(RRE <br /> BUNKHOUSE 59.692(1V)GAZEBO STAIRS FILLING/GRADING CAMPING UNIT <br /> a <br /> COMMERCIAL BUILDING COMMERCIAL ADDITION COMMERCIAL ACCESSORY STRUCTURE <br /> STRUCTURE/ADDITION USE: GG X1!1 in E7L�c���l.�JrC�a, P_ <br /> (Home/Cabin; Commercial Business; BedroWn; Deck; etc.) <br /> BUILDING CONTRACTOR: wc,6 <br /> 3� <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 /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) eri o <br /> I. 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 iT Ion <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, V <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) ° ° O <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. I p <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. II^ y <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, Nj{-v G <br /> 0o i <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. II <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: )UI ^ (JJ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. G n, Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ' °' <br /> IZ5F <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 �N <br /> SETBACK AREA. , <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. I� <br /> 6. <br /> 7. <br /> SA annn a > o "e <br /> ,p <br /> FZN3 ° ag ° _ S <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my 9 0 ° <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 > > <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I .� ,°<, ?w <br /> further accept all liability that may be a mutt of the County of Burnett relying on this information I am providing in this <br /> application. I agree to pernit county officials charged with administrating county ordinances or other authorized person to have <br /> access to the above-described mises at any reasonable time for the purpose of inspection. <br /> /d a <br /> OWNER'S SIGNATURE Id-6 D? on, p ^ 0 <br /> (date) o a F 3 " <br /> a FaM 'A <br /> ZONING ADMINISTRAT U'7l " ' o a <br /> r c <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N <br />