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N ro z <br /> Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAN USE PERMITS a <br /> OWNER TELEPHONE <br /> MAILING ADDRESS <br /> Cl <br /> PROPERTY ADDRESS T n , ,p o <br /> a <br /> LEGAL DESCRIPTION ° <br /> TYPE OF PERMrT(S): SINGLE-FAMILY DWELLING O ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE ❑ SU <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ b 4 <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE <br /> STRUCTURE/ADDIRON USE: P�4 n <br /> e <br /> oma in;Commercial Business; room; c ;etc.) �- <br /> BUILDING CONTRACTOR: y =oo C-0, <br /> 3 <br /> o <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 r/:X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. ,� c <br /> t2lO <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) T� <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. py ro "- <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW _ o <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, �j YJ a <br /> AND INDICATE NORTH(N). ° O O o <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 <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 ,n (�bj <br /> TO BUILDINGS,ROADS,LAKE, LOT LINES. W <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Q <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THEf <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. A_- <br /> NOTE: <br /> [NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. p <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: p x <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. U Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O r x <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER p 0 <br /> SETBACK AREA. C, N <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. f <br /> 6. <br /> 7. A > c o o C a 0 7 <br /> a <br /> El o <br /> zag � o = <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my „ P ? w <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of allRL Ea y <br /> Information contained in this application(including any accompanying schedule)and I further declare that I recognize that this E. 9 m `O <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit I o: E ii - ; ` a <br /> further accept all liability that may be a result of the County of Burnett relying on qft information I am providing in this <br /> application. I agree to per co ty officials charged with admini Ing cou ordinances or other authorized person to <br /> have access to the abov escri premises at n abletime r the pur eldrinspection. 5 D : y,.n 1n (� <br /> 8 > <br /> OWNER'S SIGNATURE <br /> / _ (date) C7 y� C] d m O <br /> � [ C <br /> ZONING ADMINISTRATOR I <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> C, 6 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE g <br /> PP1fVbb{ d �2We� plC(Ged 6v} �n��PaHriu� SleraYvw /�(&f11� ^ Ns000 � <br /> �N , <br />