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o Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS <br /> o � <br /> ° <br /> OWNER O FEPHONE O <br /> �J ° <br /> MAILING ADDRESS 7 y Al <br /> PROPERTY ADDRESS <br /> l ✓ (i (J / A <br /> l" Ce f'06 f TeLEGAL ESCRITION <br /> y <br /> TYPE OFOPERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION <br /> DECK ❑ GARAGE/ACCESSORY,STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING O CAMPING UNIT 0 , <br /> COMMERCIAL BUILDING 0 COMMERCI L ADDITION O COMMERCIAL AC ESSORY STR CTU RE 0 <br /> 6� T <br /> STRUCTURE/ADDITION USE: � t `U I� �""\ M� , G, c <br /> (H me/ ; Commercial Business Bedroo Peck; etc.) o <br /> BUILDING CONT CTO Q UG l 0 <br /> 70 w �Vlr �ov''G - Lv15 -(�C4 T3 0 <br /> A PLOT PLAN MUST BE PROVID D ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILEGIBE PLOT PLANS o <br /> WILL BE RETURNED. .n <br /> � � c <br /> 'n c1 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) �y 1 <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 m o \ <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, a <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) $ T <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. ° <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. <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.,THE o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN O <br /> NEEDED. O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: (A) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n z <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. C70 <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. aa° ro <br /> I declare that this application(including any accompanying schedule has been examined by me and to the best of m z ° S° <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all li. d a y <br /> Information contained in this application(Including any accompanying schedule)and I further declare that I recognize that this 9 c a Y m <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin In determining whether to issue a permit. 1 a R $ = <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing In this a ;,,;,,�.`�r^N b <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have ^ �.°z o o : 0 <br /> access to the above-described premises at any reasonable time far the purpose of Inspection. s� n <br /> m UyO d p�pp N <br /> �i <br /> .y�� m A y 6 0 0�lyi <br /> OWNER'S SIGNATURE��J It J1 \\c...sW� <br /> (date) a ° "M Oil° <br /> ZONING ADMINISTRATOR <br /> n dy C_- <br /> TOWNSHIP <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> p � U <br />