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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Adm nistrator n z <br /> APPLICATION FOR LAND USE PERMITS a <br /> zMW <br /> OWNER TELEPHONE n <br /> MAILING ADDRESS a��a/ .J(�t.I'l ✓LS�- Ct. WZ6,S ick ` CJ g� <br /> PROPERTY ADDRESS <br /> a C7 <br /> LEGAL DESCRIPTION c v' <br /> SINGLE FAMILY DWELLING 0 GARAGE/ACCESSORY STRUCTURE ADDITION ❑ 5TAIRS o p <br /> TYPE OF PERMIT(S): - <br /> FILLING/GRADING 0 CAMPING UNIT 0 BUNKHOUSE 0 59.692(1V)GAZEBO ❑ ECK 0 <br /> ./ I T <br /> STRUCTURE/ADDITION USE: Add, I lQh _fz)Q sfz/ Dry <br /> Z <br /> (Home/Cabin; CommercW Busin s; Bedroom; Deck; <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN B Ya X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE Pl.OT PLANS C r) -� <br /> WILL BE RETURNED. <br /> F < ;rC <br /> DIRECTIONS F00.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 NE ,^r <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, ,p <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) Bul LDING(S) I� n <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. NrDr' e <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF),AND ALL DISTANCES 0 1 c <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w J O <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, E C.,THE - J <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. - O <br /> — -1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DON E WHEN .� <br /> NEEDED. Lr � <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Ii�Tv\ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. IIr'. Z J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION 1S RESTRICTED ALONG SHORELINE. n x O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. k <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATI R DO <br /> SETBACK AREA. Uj <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORA E ONLY. I C� <br /> NOT TO BE USED FOR HUMAN HABITATION. E <br /> 6. <br /> x � nc ?' M <br /> 7. R <br /> ,^rw I:a +r rr <br /> ' =w3 <br /> I declare that this application(including any accompanying schedule)has been examined by me and W the best of my k wledge 3 s� E Z <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all informs on <br /> contained in this application(including any accompanying schedule)and 1 further declare that 1 recognize that this information I c M« <br /> am providing will be relied upon by Me County of Burnett Wisconsin In determining whether to Issue a permit I further cept all 'r, <br /> liability that may be a result of the County of Burnett relying on this Information I am providing In this application. I agre a to = r <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the at Dve- <br /> described premises at any reasonable a for the purpose of Inspection. to <br /> 9 <br /> OWNER'S SIGNATURE W <br /> (date) $ <br /> : u' <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE 0 fISSUANCE N € <br />