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C � O <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator < I 7 <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER(' E E ONE o <br /> a^ <br /> MAILING DR <br /> o N m <br /> PROPERTY A RE55 s w o <br /> r <br /> LEGAL DESCRIPTION o <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE A <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO❑ STAIRS❑ FILLING/GRADING L33 CAMPING UNIT❑ � <br /> o <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> o <br /> STRUCTURE/ADDITION USE: .& —� <br /> onnIn; ommeraaBusiness; room; Deck;etc.) <br /> BUILDING CONTRACTOR: <br /> _%6AVMS} t' Cow <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLATIS <br /> 6 <br /> WILL BE RETURNED. <br /> n O <br /> DIRECTIONS FOR 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 NEW O c <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, N —4u <br /> � <br /> AND INDICATE NORTH(N). O o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK d <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. QJ <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES70 <br /> TO BUILDINGS,ROADS, LAKE, LOT LINES. 73 a <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. _L_ —(- <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER; BUILDER,CONTRACTOR,ETC.,THE J <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. \/ <br /> y ) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN (y) r W <br /> NEEDED. <br /> n <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: � n <br /> z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 'z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Q <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. w <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER rG <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> D � o o nc0 'O <br /> r, n N333 c � <br /> 7. � 'z A3 � oo' E <br /> A rr <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my F _ $ `3 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all $ c a a d '_ <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize thY <br /> at this a, n �'°p ;,d, e, > <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I ;: n w' o 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 g W o 8 o �^ <br /> application. I agree to permit county officials ch p awith administrating county ordinances or other authid person to have n <br /> access to the above-described remises at ble pur of pection. 3 m H x 8 0 8 o y <br /> OWNER'S SIGNATURE rt 12:L <br /> rZONING ADMINISTRATORJUL 2 7 2012 TOWNSHIP PE MITS MAY BE REQUIREDTHIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUA ti » L- <br /> BURNETTCOU <br /> ZONING <br />