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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a 3 z <br /> APPLICATION FO LAND USE PERMITS <br /> O' C <br /> OWNER.I/ f° <br /> TELEPHONE7l <br /> m <br /> MAILING ADDRESS ~7 ° <br /> �DROpERTY AESS - <br /> C � <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMR(S): SINGLE- AM LY 5v ELL NSG ❑ A FT MN�'3EC�K❑ GA G /ACCESSORY S RUCiURE � <br /> BUNKHOUSE ❑ 59.692(IV)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTUR ❑ c <br /> STRUCTURE/ADDITION USE• '� I z <br /> (Home/Cabin; Comm e tial mes room; Deck; etc.) P <br /> BUILDING CONTRACTOR: <br /> n <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN B Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. <br /> n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, a <br /> AND INDICATE NORTH (N). z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) o o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. p <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. - y <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED, <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE o LT2 <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 lu <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ° <br /> n <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. F <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER y <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. F <br /> 7. annn0> a V <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 0 ° n A d <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all v' 2 n.rn y <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this E.D D m ° - <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I Y <br /> c - <br /> further accept all liability that may be a result of the County of Burnett relying on this Information i am providing in this <br /> application. I agree to permit county dale charged with atlministredng county ordinances or other authorized person to have c m,°� e c 8 c r, <br /> access to the above-described premi at any reasonable time for t purpose o inspection. <br /> y 00000g H <br /> OWNER'S SIGNATURE <br /> nrn a - mn w _n0 <br /> (date) $ `= 3 R = z <br /> ZONING ADMINISTRATOR \ I I �)fi{r�� y ��! $ w ', o <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE „^ »H <br /> U' 8oa . <br /> 0 0 <br />