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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator n z <br /> APPLICATION FOR LAND USE PERMITS a <br /> a <br /> OWNERTELEPHONE <br /> &AIZ IS S w 4r,)J;14J ° <br /> MAILING ADDRESS 0-7 �� 4 �/�f/n A 1.0A/ 5- <br /> PROPERTY ADDRESS <br /> LEGAL DEScFrRIPTION o <br /> ,� Q�roLJ <br /> SINGLE FAMILY DWELLING &RAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ STAIRS ❑ o <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADINGI CAMPINNGG UNIT❑ BUNKHOUSE ❑ 59.692(1V)GAZE <br /> BO 0 DECK ❑ ^ <br /> STRUCTURE/ADDITION USE: <br /> /% C <br /> /7� A-1 Y <br /> (Home/Cabin; Corafnercial Business; Bed(com; Deck;netc.) // /! o_ <br /> BUILDING CONTRACTOR: If� Nlf' DLMn..�_l �[�71� C. LGc`Gy�x�� 9D <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Ya X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS rni. <br /> WILL BE RETURNED. O� < <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. tnn d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW C <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) c <br /> TO CENTERLINE OF ROAD, (C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK e <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. N y <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. A <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O c <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE 4 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> 1 YJ <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: <br /> r z <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. n <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. I^ <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER P _ <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 /> w r� <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowkjdge � ;'a <br /> and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information e <br /> contained In this application(including any accompanying schedule)and I further declare that I recognize that this Information I <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit I further acceipt all c N=w 7 <br /> liability that may be a rewIt of th County of Bumett relying on this information I am providing in this application. I agree to ^ n'8 <br /> permit county olfidals charge0 administrating county ordinances or other authorized person to have access to the above- ' 5 fj <br /> described premises at any so b time for the purpose of inspection. m A a a y <br /> R <br /> ELI <br /> 4-0 <br /> OWNER'S SIGNATU �+ e n � S J n °x <br /> (date) cs 6 $ KI <br /> i M <br /> ZONING ADMINISTRATOR 111 c-In 10" <br /> a <br /> TOWNSHIP PERMITS MAY BE REQUIRED «R <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE W " <br /> o �No <br />