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N � z <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator g o <br /> APPLICATION FOR LAND USE PERMITS a <br /> OWNER /) ,( I /n TELEPHONE P <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION <br /> s <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCRIRE � <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ '< <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ S '� <br /> STRUCTURE/ADDITION USE: ? <br /> ome a m; meroa u_qness; Bedroom; Deck;e o) <br /> BUILDING CONTRACTOR: <br /> p 3 <br /> o y <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 rh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O � <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) M d O <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 O o <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH(N). O o Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) Y % ? <br /> TO CENTERLINE OF ROAD,(C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK G <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 DISTANCES <br /> TO BUILDINGS,ROADS,LAKE,LOT LINES. S_ " 1 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o (� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE J F <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER, p� ' <br /> JJ ^ w <br /> CA <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. .L Q <br /> e <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: G <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. d n Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 8 O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. _ <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. 60 <br /> NOT TO BE USED FOR HUMAN HABITATION. f <br /> 6. O <br /> 7. 77 Dn nn C) a O '0 <br /> N a n tz1 <br /> Fr' 3 El c a._. <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 p o <br /> 9 ? w' <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this °.S D m 2Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I c a W-= > <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this b <br /> application. I agree to Fermi my omc s charged wlth administrating county ordinancet or other authorized person to Q i c : g <br /> have access to the aborr n d p any reasonable time for the purpose of i9gpectiQn W a W W ti a <br /> OWNER'S SIGNATU L- ,off) S M <br /> (date) n cn 9 <br /> /jam <br /> ZONING ADMINI RATOR �M ((itJ I ( N au°, .� <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> d I a 5 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE g <br /> IP. rqt i pc'_44 ttp bul Tr-h <br /> V <br />