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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator N O <br /> APPLICATION FOR LAND USE PERMITS U1 <br /> o � � <br /> OWNERLEPHONE <br /> O <br /> i <br /> MAILING ADDRESS J 8 3 <br /> J dA <br /> PROPERTY ADDRESS m � <br /> lI i <br /> o <br /> LEGAL DESCRIPTIONr- a� <br /> \Yll <br /> SINGLE FAMILY DWELLING GARAGE/ACCESSORYUCiO ADDITION 0 STAI S ❑ ,pr, <br /> TYPE OF PERMIT(S): <br /> FILLING/GRAD NG 0 CAMPING UNIT 0 BUNKHOUSE 0 59.692(1V)GAZEBO 0 DECK 0 �- <br /> STRUCTURE/ADDITION USE: % a z <br /> S <br /> Home/ Commercial <br /> al Business; Bedroom; Deck; etc.) i <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vac X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT qLANg C 3 <br /> WILL BE RETURNED. 71 <br /> I C o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <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 <br /> m <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, M w <br /> AND INDICATE NORTH (N). I i n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) 9 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARKIT .p <br /> 4. SHOWTHE(OHWMFLAKE, STREAM OR RIVER AND WETLAND LOCATION OF THE WELL(W)SEPTIC TANK(8T) AND DRAINFIELD AS, AND (D) LOT DIMENS(D) ONS <br /> I AND ALL DIST�NCES m <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. tl0 Q <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o .91 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC. THE 5. <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. y <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE HEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. cFo A <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE(ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. r 3 p d -0 <br /> R _ <br /> 7. A <br /> N <br /> � <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my kno edge <br /> and belief R Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Infonna o e ? <br /> contained in this application(Including any accompanying schedule)and I further declare that I recognize that this informs I m v. <br /> am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further pt alli_ '� ,'�, U N 8 b <br /> liability that may be a result of the County of Burnett retying on this Information I am providing In this application. I agree <br /> permit county officials charged with administratlng county ordinances or other authorized person to have access to the abo 6L 6 c y <br /> described promises at any reasonable time for the purpose of Inspection. a <br /> a g m� C <br /> 7-3D-ti <br /> OWNERS SIGNATURE— (date) w 5 a <br /> mac : tr <br /> ZONING ADMINISTRATOR 8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> SUANCE <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISN <br />