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n z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g 3 <br /> APPLICATION FOR LAND USE PERMITS y <br /> n <br /> OWNER TELEPHON_ o. <br /> L�ja - £s' C3 <br /> 0 <br /> MAI DD ESS J <br /> A7/V7 12W <br /> l <br /> P ERTY AD/DR ES ` <br /> pl�96S-G .2 oo Tt <br /> L ALD SCRIPTIOI�J /�//1 /I I1 _ li["/ o_ N <br /> ,D ( N �/ G� V-f/,, JCYO O <br /> TYPE OF PERMrr(S): S GLE-FAMILY DWELLING A ITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE 0 <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> o <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: O , c A <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> O 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS c <br /> WILL BE RETURNED. e <br /> n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) p <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 NEW Vit ° 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). o z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) ° <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK wE <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. p O <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTANCES A <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. ^ H <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 9J SU <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. O �D <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN .i <br /> �. <br /> NEEDED. Ul <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: `� C P <br /> n <br /> (7 J J <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n z <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? <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER O <br /> SETBACK AREA. U O <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. T o 0 0 <br /> 'f, <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 0,°2 �_n A ' w <br /> knowledge and belief R 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 a 2z D n N Y <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I R ?w v y <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In thisFF c S w—N- <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have O'2 o 8 <br /> access to the above-described p se It any reason tl for the purpose of inspection. m w 9 a pl w N Y <br /> ac 'o88 ,� <br /> OWNER'S SIGNATURECIE .,> a»m n mn O <br /> (date) w ° _6 E 2 <br /> 00': '.w R� iy <br /> ZONING ADMINISTRATOR in iy w : t+�1 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE O„ <br /> �� 80008 <br />