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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a z <br /> APPLICATION FOR LAND USE PERMITSw <br /> z <br /> OWNER c <br /> TELEPHONE <br /> J O <br /> MAILING ADDRESS t73 00 <br /> m <br /> PROPERTY ADDRESS <br /> 11/� p(/ _ <br /> 71E <br /> n /' < <br /> LEGAL DESCRIPTION 1 <br /> l 1 T 0 <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ADDITION ❑ DECK <br /> E/ACCESS STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZESO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ JI7V <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ r C-)_ <br /> 0 <br /> STRUCTURE/ADDITION USE: <br /> (Home/ bin; Commercial Business; Bedroom; Deck; etc.) ? T, <br /> BUILDING CONTRACTOR: ^fro <br /> w <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yx X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. O <br /> � Fn <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) n I a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. r O <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, m w " Bo <br /> AND INDICATE NORTH (N). CU <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) S' <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK �' I <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. r—).' O <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF),AND ALL DISTANCES (j b Gd <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. O� g. <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 <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 ; -a <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WTHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. a O' <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARA <br /> 6. <br /> GE STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> ecP /MoT � l�P��C �oas� t�1 L'/�0 PBI T >0 0 0 p�p± $ b <br /> 1 declare that this application(Including any accompanying schedule)has been examined by me and to the best of my c ° . " . <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of allc M w U <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this A m a a w <br /> Information I am providing will be relied upon by the County of Burned:Wisconsin in determining whether to Issue a permit. 1N <br /> ? n $ a a <br /> further accept all liability that may be a result of the County of Bumett relying on this Information I am providing in this c <br /> 5 w <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized — $ `� ,. _ 8 ro <br /> access to the above-described premises at a reaso time for the purp action person to have c m g g 8 8 .r. <br /> n � aawN? n <br /> OWNER'S SIGNATURE o2j A 5 ,a, 8 8 c 8 0 -i <br /> o a y <br /> (date) c ss a _: g n m ±: O <br /> i; 3p6= z <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROMATE OF ISSUANCE <br /> -�l- d Qr<�r <br />