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c o <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g � » <br /> APPLICATION FOR LAND USE PERMITS �. m <br /> OWNER _ /iT e_ TELEPHONE <br /> MAILING ADDRESS - Pa 'eck q—s / X � Svolz( V <br /> PROPERTY ADDRESS �-7 /� LL / -�� /°(d2dL O��t2 /✓t/7 o <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMTT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK/❑ GARAGE/ACCESSORY STRUCTUREAr S <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> ro y <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ c <br /> STRUCTURE/ADDITION USE: S4 c <br /> (Home/Cabin; Commerc' I Business; Bedroom; Deck; etc.) p <br /> BUILDING CONTRACTOR: c r� <br /> A PLOT PLAN MUST BE PROVIDED ON AN B%X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O c <br /> WILL BE RETURNED. <br /> L 6 <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 m <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, a <br /> AND INDICATE NORTH (N). N p ' o <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 MEASUREMENTS)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. t7 Q) <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD(DF),AND ALL DISTANCES t"jp <br /> TO BUILDINGS,ROADS, LAKE, LOT LINES. 2 y <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 -1b <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 w ,.� <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n z p <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER V" <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> qp > gng gng t33� [» 7 <br /> 7. <br /> in` z o A S <br /> I declare that tits application(hKluding any accompanying schedule)has been examined by me and to the best d my 3 ? ,� �. :.9 <br /> knowledge and belld It Is true,correct and oomplete. I admowledpe that I am r asp, for the deteil and accuracy of all 9. w a <br /> Infomutlon contained In this application(Including any accompanying )and I ftxdw dedare that I recognize that this v E. Y c w N <br /> Inliormaoon I awn providing Will be relied upon by the County of Burnett Whic rWn In determining whether to Issue a permit. I <br /> fu.to m accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this <br /> application. I agree to pert county <br /> officials charged with admhuls[rating county ordinances or other authorized person[o have d S . 0 0 t; <br /> access to the above-described premises at any r time for the purpose of Irspectlan. <br /> 0 0 0 o D <br /> c00000 <br /> OWNER'S SIGNATURE - y m n c m 0 <br /> (date) t' <br /> �'� T <br /> ZONING ADMINISTRATOR_�1 '_m a __. ___ J= N = n <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> J N O G C C O <br />