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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator ° <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER TELEPHONE _ Ci w <br /> / m( `� <br /> W <br /> MAILING ADORESCjp- <br /> Mx L <br /> PROPERTY ADDRESSZqW: r— <br /> LEGAL DESCRIPTION r ar A Y <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITIONx STANSO <br /> O <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT❑ BUNKHOUSE ❑ DE :K ❑ <br /> STRUCTURE/ADDITION USE: k�rl <br /> (Home/Cabi ; Commercial Business; Bedroom; Deck; etc.yS. <br /> BUILDING CONTRACTOR: r' <br /> � v <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 W X11 SHEET OF APER. ANY INCOMPLETE OR ILLEGIBLE PLO PLANS C <br /> WILL BE RETURNED. 0 <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AREAL OR TOP VI ) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. p O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING B ILDINGS/STRUCTURES (EB)AND ALL NEW w I�C(f/•I '`% <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, in <br /> AND INDICATE NORTH (N). n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (k) BUILDING(S)TO ALL LOT LINES, (B) BUIL ING(S) .0 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASURE ENT(S)TO THE ORDINARY HIGH WATER MA z <br /> (OHWTO WETLAD AREAS. <br /> 4. SHOW THE LOCATIONOF LAKE, REAM OF THE ELLOR RIVE(W)SEPTIC TA K AND MEASURE (ST)AND DRAINFIELD (DF), AND ALL DIS7 ANCES _A ° <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. A <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED At D SHOW AREAS TO BE GRADED OR FILLED. n £ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHIT ECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE w .; <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNEI L. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKE SO AN ONSITE VERIFICATION MY BE DONE WHEN a <br /> NEEDED. $ ^ v <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIRE14ENTS WITHIN 60 DAYS OF PERMIT. <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 WATE I 'J <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW OR PRIVATE RESIDENTIAL GARAGE/STORAG ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. qq o <br /> 6. � R' aR $ E trgai <br /> = w3 <br /> I declare that this application(Including any accompanying schedule) uis been examined by me and to the best of MY krx vviedge <br /> and belief It Is true,correc and complete. I acknowledge that I am n sponsible for the detail and aauracy of all Informati o 2 c y <br /> wrhcalncd in this application(Including any ac schedule) d I hither declare tint I recognize that this I on I 9 « « b <br /> am prwAdbg will be relied upon by the County of Burnett Wisconsin determining whether to Issue s Permit I further all 'o " <br /> IlabBity that may be a result of the County of Burnett relying on this 1 on I am pra A Ing in this application. [ to ^ r 1�,Cr <br /> permit county officials charged with administrating county ordinances otihe autfhalzed person to have saes to the ° veyPi n <br /> described premises at any rsawnable time for the purpose of m v/P" n B e=' -1 <br /> , C / cr Y. <br /> s Lo ' v Z <br /> SIGN HE L <br /> (signature of ormer of building, ) (data] N $ : a w -4 <br /> ZONING ADMINISTRATOR m ( h <br /> TOWNSHIP PERMTfS MAY BE REQUIRED v C! piA YEAR Z <br /> u O D U O <br /> THIS PERMIT SHALL EXPIRE ONE R FROM DATE OF ISSUANCE 7 <br /> I`�rn�k �- le-}--}c� ✓nGiilx/,{ -}� Northland 13uli�e�s <br />