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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator L �oz <br /> APPLICATION FOR LAND USE PERMITS a ° <br /> OWNER TELEPHONE � �5 �O•r� _� 5 <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION , g) <br /> C-1 t 1 C�+`r\ 1-7.5 i\C)/4 Y\w'/4 ` cec :�-C.- 1 U„�p �9 �Z fir\L e l� l:� <br /> SINGLE FAMILY DWELLING ❑ GARAGE ACCESSORY STRUCTURE ❑ ADDITION ❑ STAIRS ❑ <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING 0 CAMPING UN TX BUNKHOUSE EI59.692(1V)GAZEBO ❑ DECK ❑ <br /> STRUCTURE/ADDITION USE: a <br /> (Home/ abin, Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: W <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 �h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS r) <br /> WILL BE RETURNED. <br /> PIgC.ie\c, cc trpe� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) SAmz 0Cu-N-6On o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. c <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW G g <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, ,4v'i <br /> AND INDICATE NORTH (N). W <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 3 <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. N a <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. .0 <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. d c <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: WHEN <br /> NG/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE W <br /> NEEDS uI <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> W <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 2 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. `° a <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. y <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. <br /> NOT TO BE USED FOR HUMAN HABITATION. �. <br /> 6. <br /> 7 � St1 �'�Jn` � OaCb <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge w 9 <br /> .. <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information I w Y <br /> am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all n <br /> liability Nat may be a result of the County of Burnett relying on this Information I am providing In this application. I agree to 8 N 8 tro' <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- o <br /> described premises at any reasonable time for the purpose of Inspection. m m' <br /> Nz = > <br /> RE � o A Sw OOWNER'S SIGNATU '�� <br /> a 2 <br /> T (date) _c <br /> ZONING ADMINISTRATOR <br /> u < p <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE v w w <br /> o� � o <br />