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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator n o <br /> APPLICATION FOR LAND USE PERMITS d . <br /> OWNER ��. `r I TELEPHONE <br /> n <br /> MAILING ADDRESS �1(� _ <br /> PROPERTY ADDRESS <br /> c13�0 S �e \ Ar ti W _ <br /> LEGAL DESCRIPTION y <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ STAIRS ❑ ,or, <br /> TYPE OF PERMIT(S): ,9 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK O <br /> STRUCTURE/ADDITION USE: O-lw.�e. Z <br /> (Home/Cabi�-, c m�me`rcial Busine s; Bedroom; Deck;; etc.), o T <br /> BUILDING CONTRACTOR: X15. SOA � U�a��,�. ti-n-c� i <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS +f y <br /> WILL BE RETURNED. C <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 0 j <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW y ^. <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, M w' <br /> AND INDICATE NORTH (N). 7� Q <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) 3 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK r <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND (D)LOT DIMENSIONS. c w `X% 2 <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES '. P <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. va <br /> S. 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/STRUCiURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> v <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Y t O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n �� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. h <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. E I <br /> 6. <br /> s7. b <br /> x� �w <br /> I declare that this application(Induding any accompanying schedule)has been examined by me and to the best of my knowledge <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detall and accuracy of all Informatione <br /> contained In this application(including any accompanying schedule)and 1 further declare that I recognize that this Information I 1 ,, <br /> am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit I further accept All jO c N`=w N"' 7 <br /> (lability that may be a result of the County of Burnett relying on this Information I am providing in this application. I agree to _ <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- Z B f1 <br /> described premises at any reasonab Ime for the pu f inspection. m n v,Ns= > <br /> h � n_ �� <br /> OWNER'S SIGNATURE r,t T ,m�nen �i " n g > 2 <br /> T_ \ /{ � <br /> (date) F� H : �O ° a - �1 <br /> ZONING ADMINISTRATOR `J fm Fla n <br /> r <br /> TOWNSHIP PERMITS MAY BE REQUIRED - <br /> »» � <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N <br /> ^ d 8 U ; <br />