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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER rn <br /> l/�5 ejCp(h TELEPHONE QI 1713 <br /> /y/ O (S1 <br /> MAILING ADDRESSIJ <br /> _ arh,s3 <br /> PROPERTY ADDRESS <br /> <J I <br /> LEGAL DESCRIPTION � Q_ <br /> TYPE OF PERMrr(S): SINGLE-FAMILY DWELLING ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE ❑ '_ m - 1 <br /> h <br /> BUNKHOUSE ❑ 59.692(SV)GAZEBO O STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ � <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION CI COMMERCIAL ACCESSORY STRUCTURE ❑ c <br /> � <br /> STRUCTURE/ADDITION USE: I{1 Dai,e. z fF <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) I P W <br /> BUILDING CONTRACTOR: UJ <br /> n <br /> m � _ <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS A o <br /> WILL BE RETURNED. O — <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) A <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. c I O <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 v <br /> AND INDICATE NORTH (N). <br /> 3. BUILDING(S) <br /> SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) <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 �V <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. m 1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE <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 ,.,.i O <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. C w <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. '9 1"0 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. Ca <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. <br /> ^ 7,ya� 9P a v <br /> R n ^ 3 3 3 a <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my c ' o ^ o g°e ' <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all a La E.a ^y <br /> Information contained In this application(including any accompanying schedule)and I further declare that I recognize that this '�E D D m e ! Y <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I <br /> further accept all liability that may be a result of the County of Burnett relying on this Infonnatlon I am providing in this 'd <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have �- �,°7 H^'! 8 c trot, <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. ^ pDp g g o g g y <br /> OWNER'S SIGNATURE ro'�g <br /> (date) o 0n 1`g° 6.— Z <br /> ZONING ADMINISTRATORlo n ( �C( {� •'Z �.Jy o "g <br /> e mC: m� ts7 <br /> TOWNSHIP PERMITS MAY BE REQUIRED n <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE «N»»«» <br /> SPC✓m( I � �e.�.� rra� Vd fo Umar � 6�1e1�, 9-l� � c�� so0os <br />