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� � O <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g 3. <br /> APPLICATION FOR LAND USE PERMITS o <br /> --� �7/�/� / '7/s-agu-y?�a <br /> IIIYr�tn'hl',%u"'YL� IC�{'YI/YlG�/rt l'1 j"�Dhy TELEPHONE Nam. <br /> OWNER /I 4r//1,Id4- K.A t'�,i <br /> MAILING ADDRESS 1 q 3 a ��, /Y �� � l� �� 5qs <br /> U l � C JC- <br /> PROPERTY ADDRESS <br /> r <br /> LEGAL DESCRIPTION <br /> Ur S <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION STAIRS ❑ �. <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ r <br /> STRUCTURE/ADDITION USE: <br /> (Hom/ee//,C.,abin; Commercial Business; Bedroom; Deck; etc.) z � <br /> BUILDING CONTRACTOR: <br /> n _ <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS h } <br /> WILL BE RETURNED. <br /> DIRECRONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) n c S <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW b <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) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) N o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARKQ �„ V <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. �? <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. <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 7� <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: S <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. r1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. B Z <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER �y <br /> SETBACK AREA. <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. <br /> aoro <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge m Q R R I M <br /> and belief It is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of all Information RF <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 relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all N y <br /> liability that may be a result of the County of Burnett relying on this Information I am providing in this application. I agree to m _: j <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- '°� Q�TR 7 <br /> described premises at any reasonable time for the purpose of Inspection. <br /> B �N <br /> , •m.H <br /> OWNER'S SIGNATURE� -4-)21 <br /> -rr L �v�'^'f (date <br /> m m <br /> ` <br /> ZONING ADMINISTRATORm aw <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE of <br /> 5 : <br /> n c <br />