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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator a ° <br /> APPLICATION FOR LAND USE PERMITS <br /> o a <br /> OWNER / TELEPHONE <br /> c,�wrc ✓ /ev !PS!-a�8-378 <br /> 0 <br /> MAILING ADDRESS <br /> V, <br /> PROPERTY ADDRESS oLn <br /> 0 <br /> LEGAL DESCRIPTION / 2 <br /> A4 Rd, w 4> fJ 'c O <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADD ON ❑ DEC�W GARAGE/ACCESSORY STRUCTUR a <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO❑ STAIRS❑ FILLING/GRADING ❑ CAMPING UNIT ❑ r R. <br /> 0 <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ <br /> (^ o <br /> STRUCTURE/ADDITION USE: e i / Ali) AJPAkA <br /> ome a m;Wrnmerdal bushess; a roo ec ,etc.) <br /> BUILDING CONTRACTOR: 3 <br /> O c <br /> X1 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 6'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLA(IS � $. <br /> WILL BE RETURNED. hl <br /> `n d <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) C �. <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 ts7 R. 0 <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, J a <br /> AND INDICATE NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) O ° <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK �u ~ <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. �C y <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES RJ <br /> TO BUILDINGS, ROADS,LAKE, LOT LINES. ` o <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 <br /> NEEDED. r <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. G <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. SVj <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' ^ yy aDo7 <br /> n °mom 3 3 3 ? ry <br /> 7. <br /> n 3 <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my m W <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all c c a a= Y <br /> Information contained in this application(Including any accompanying schedule)and I further declare that I recognize that this <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I m n N o (c <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing in thisi 0 - O " <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have m on �,"w N n <br /> access to the above-described premise any reasonable time for the purpose of inspection. y <br /> OWNER'S SIGNATURE <br /> (date) <br /> ZONING ADMINISTRATORIm "�(� ^�(1 —7 d °q n M <br /> ^a a aC : � aP7 <br /> m o <br /> TOWNSHIP PERMITS AY BE REQUIRED _ <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCES ti U o <br /> V <br />