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�o z <br /> c � o <br /> 6 <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <' <br /> APPLICATION FOR LAND USE PERMITS <br /> a <br /> OWNER Pe TELEPHONE <br /> 0 <br /> MAILING ADDRESS s <br /> .17 <br /> PROPERTY ADDRESS 7/ ,�1 o I <br /> LEGAL DESCRIPTION IG� 17u/ <br /> yi ftrd S urre M nG' 1/3 ` VO dJL/ PGye y. o <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> C <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS 0 FILLING/GRADING ❑ CAMPING UNIT❑ q <br /> -o <br /> COMMERCIAL BUILDING ❑ COMMERCIALADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ <br /> STRUCTURE/ADDITION USE: �C' l 'e o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> — <br /> BUILDING CONTRACTOR: <br /> � o <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. !rI c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) J O <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 o <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH(N). e 1 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S) 3 ° 1 <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 o �, <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o VV <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE 10 V" <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> 013 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN SU <br /> NEEDED. N <br /> r <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: m U) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. H 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. <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 GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> /. � aa ° <br /> Ei <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief it 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 D m N <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit I .ap <br /> further accept all liability that may be a result of the County otBurnett relying on this information I am providing in this <br /> application. I agree to permit county officials cha ed administrating county ordinances or other authorized person to <br /> have access to the above-describ p mise sonable time for the purpose of inspection. 'm o i w zs ss w O <br /> m w Le,„U o0 9 <br /> OWNER'S SIGNATURE 9 <br /> (d ) n � aaandRd O <br /> 6. j <br /> ZONING ADMINISTRATOR nn <br /> OCT 22012 y N <br /> Pc : � a <br /> TOWNSHIP PERMITS MAY BE REQUIRE <br /> �� . <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OFEI&Rk%ff <br /> I g <br /> � <br /> � <br /> UNTYZONING N N o <br />