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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator 3 P <br /> APPLICATION FOR LAND USE PERMITS = Al <br /> n c� <br /> OWNER 6a <br /> , /I d „r I 'Om TELEPHONE <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS bo✓a-loW, (i Ircle <br /> C> /� CJ i� <br /> LEGAL DESCRIPTION I� ','jo <br /> I c_ <br /> TYPE OF PERMTr(S): SINGLE-FAMILY DWELLING ❑ ADDITION DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS 11FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL AD�QJ`STION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ = � <br /> \� <br /> STRUCTURE/ADDITION USE: r <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: j w <br /> O 3 100 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 6 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS � c <br /> WILL BE RETURNED. - -! <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 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 r u; •='' <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). }vZ <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) W <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK m O Q <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. — r <br /> S. 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., THEo (J� <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. p <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. I ` <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: I� `' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. W <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Z CEJ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. D <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. �// � 9 � oK 6 �s!f <br /> s 4 r R IS S C zi <br /> zi /•• <br /> I dedare that this application(Including any accompanying schedule)has been examined by me and to the best of my a e p 2 a a P - <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all 2 E ai -i <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that thisS. > > a N ; <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permlt. I .-'. �,� [ Dp <br /> further accept all liability that may be a result of the County of Burrwtt relying on this information I am providing In this `c C L,1, '^;' 'v <br /> application. I agree to permit county officials charged w admini ting county ordinances or other authorized person to have " o g <br /> access to the above-described premises at any eason le me f e purpose of Inspection. Sd w w n <br /> D <br /> 3 S > O <br /> 5 1 I Z� <br /> OWNER'S SIGNATURE (date) ^� € = 3 <br /> ZONING ADMINISTRATOR _PM �� Lf�, Lel CZr <br /> v v rz C L <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE vd =N w v H <br />