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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator o Z <br /> APPLICATION FOR LAND USE PERMITS g <br /> OWNER TELEPHONE <br /> c, J / f <br /> MAILING ADDRESS / (� I /� �.5 "le J. d.-i.-� i�Y✓c S <br /> PROPERTY ADDREI 21/0 <br /> O <br /> LEGAL DESCRIPTION J — <br /> 7e ems; dh c. 6; 4-6"A 5 <br /> DWELLING/BUILDING GARAGE CCESSORY STRUCTURE ❑ AD ITION ❑ STAIRS ❑ 6 <br /> TYPE OF PERMIT(S): b <br /> FILLING/GRADING ❑ CAMPING UNIT❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ <br /> STRUCTURE/ADDITION USE: `� � ���„�, 3 <br /> lnomxo commercial Business; Bedroom; Deck; etc.) o <br /> BUILDING CONTRACTOR: e 1I00� <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS f� <br /> WILL BE RETURNED. Otis' 1 day <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> �9��� <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 y <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). .,i <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) n <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE OR HIGH WATER MARK I C ,0 <br /> (OHWM) OF LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 'Z <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES r A Z <br /> c <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. � <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. n c O <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE y Q) <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. m C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN Iy <br /> NEEDED. ,n a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 9 n <br /> m <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. ? On3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 3 C <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER I C <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> 6. NOT TO BE USED FOR HUMAN HABITATION. <br /> � � � nm`� dE ts1 <br /> 7' n n <br /> [declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge B <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 > <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept allB H �+ -Vliability that may be a result of the County of Burnett relying on this Information I am providing In this application. lagree o �� g <br /> permit county officials charged with administrating county ordinances or other authorized person m have access to the abovteo- S ^�H U <br /> described premises at any reasonable time for the purpose of Inspection. r) <br /> Iwo <br /> SIGN HERE <br /> (signature of owner or—building cont(actor) n f° n Z <br /> c (date) <br /> ZONING ADMINISTRATOR \ /✓n F/�/1 l�,(ac�'� = "° <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE g U o <br />