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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator Z <br /> APPLICATION FOR LAND USE PERMITS a . <br /> OWNER�� � � �������O��EPHONE <br /> MAILING <br /> PROPERTY AD�I��� <br /> LEGAL DESCRIPTION c <br /> 5 <br /> SINGLE FAMILY DWELLING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ STAIRS ❑ o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING O CAMPING UNIT❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK❑ I^ 4- <br /> STRUCTURE/ADDITION <br /> STRUCTURE/ADDITION USE: \—\c>�C\e— <br /> `� _ —(Home/Cabin; Commercial Business; Bedroom; Deck; etc.) c <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS n O <br /> WILL BE RETURNED. W <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <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 C A <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) BUILDINGS) n <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK v <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. N �, <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 /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. d 0 C> <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE a w <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: CA <br /> ^ w0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. z 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE, n A <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. k- <br /> S. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER �SETBACK AREA.ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> � anm� 9 troyy <br /> I declare that this appliratlon(Including 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 detail and accuracy of all Information e <br /> contained In this application(Induding 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 <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 In <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- S R `" <br /> described premises at any reasonable ti r the p ose Inspection. m A = <br /> OWNER'S SIGNATU <br /> � wa9z <br /> (date) § H : �g > a <br /> 2 $ , <br /> ZONING ADMINIST 'a <br /> RA 1 <br /> < i P <br /> TOWNSHIP PERMITS MAY BE REQUIRED y <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE 8 o <br />