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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administra or z <br /> APPLICATION FOR LAND USE PERMITS a <br /> _V_ <br /> MAILING <br /> TELE OI.� <br /> MAILING ADDRESS ee� L/ p OCA <br /> PROPERTY ADDRESSI <br /> O P Gvi' d I")I y`I <br /> LEGAL DEscmfrI�, ' :X <br /> O <br /> TYPE OF PEfiMCf(S): <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑?STAIR 3 [1o ,e <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ I BUNKHOUSE ❑ 59.692(1V)GAZEB DECK <br /> STRUCTURE/ADDITION USE: GCIt,IOLGSG - A-41' <br /> z <br /> (Home/Cabin; Commercial Business; Bedroom; Dec tc.) o <br /> BUILDING CONTRACTOR: ss <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 rh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLNNS r) <br /> WILL BE RETURNED. O� < <br /> DIRECTIONS FOR PLOT PLAN DRAWING o_(ARIAL OR TOP VIEW) "� n II <br /> 6 <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 C 8 <br /> BUILDINGS/STRUCTURES (NE), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). \) <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDIN (S) 11J c <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK S <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. N w O <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTAN ES 0 •� o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w' <br /> 5. 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.,T E _ <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 Cal <br /> NEEDED. C"j <br /> THIS PERMIT IS SURIECT TO ALL CONDITIONS LISTED BELOW: <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. B O <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 OP LY, <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> � ry� anmoaoro <br /> 7. y � on a ; <br /> 'w' 0 : <br /> w <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowled le <br /> and belief It Is[rue,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information ,. a <br /> contained In this application(including any accompanying schedule)and I further declare that I recognize that this Information <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to issue a permit. I further accept all c <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 <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- 8 O g <br /> described premises at any reasonable time for the purpose of Inspection. to n <br /> OWNER'S SIGNATURE n O 00 <br /> (date) <br /> �7 <br /> ZONING ADMINISTRATORi o �+ <br /> TOWNSHIP PERMITS MAY BE REQUIRED C <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROMDATEOF ISSUANCE oN o o <br /> Pe✓,, 4- d-�t�l �2/ /11CCt �QF�{ -6 J t°✓D/1 t2 Q( l Gm "aJ�"0� <br />