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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrato n o <br /> APPLICATION FOR LAND USE PERMITS a <br /> m � <br /> /� e � <br /> OWNER TELEPHONE <br /> MAILING ADDRESS ] <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION Cs� <br /> SINGLE FAMILY DWELLING GARAGE/ACCESSORY STRUCTURE O ADDITION ❑ STAIRS <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ BUNKHOUSE ❑ S9.692(1V)GAZEBO/� DECK ❑ _ <br /> STRUCTURE/ADDITION USE: c c <br /> (ome/Cabin; Commercial Business; Bedroom; Deck; etc.) _ p <br /> BUILDING CONTRACTOR: I <br /> r <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 !4 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLAN S <br /> WILL BE RETURNED. <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARULL OR TOP VIEW) n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C I� m0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW ci y, <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, M <br /> AND INDICATE NORTH (N). 1-" <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) c <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK Isu <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 DISTANCE _. <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w° O <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE "a <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: NEEDEDG/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: IC <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ' Z pC� <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. N <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. _ a <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY <br /> NOT TO BE USED FOR HUMAN HABITATION. E <br /> 6. <br /> 7. <br /> I declare that this application(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 g <br /> contained In this application(Including any accompanying schedule)and 1 further declare that 1 recognize that this Information I B <br /> am providing will be relied 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 Infornation I am providing In this application. I agree to o u o o y <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- B A <br /> described premises at any reasonable time for the purpose of Inspection. -I� o':4 y <br /> m <br /> OWNER'S SIGNATURE e n ' $ a Z <br /> (date) H e S <br /> ZONING ADMINISTRATOR y �: o' <br /> O: 5 <br /> TOWNSHIP PERMITS MAY BE REQUIRED _ <br /> fA fA <br /> )�HIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE C07N 8 N o <br />