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y 9 O <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER �� J� TELEPHONE <br /> MAILING ADDRESS (J / 0 E-Al <br /> PROPERTY ADDRESS <br /> Q_:_ <br /> tl LCYI� n f <br /> G S <br /> LEGAL DESCRIPTION C- p <br /> 0 <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ v, <br /> m <br /> 0 <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ C MMERCIA�ON ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ o .� <br /> STRUCTURE/ADDITION USE: Z <br /> 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> n <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 81h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m <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 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, Q q <br /> AND INDICATE NORTH (N). �t z <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 w' O <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. I O <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 /> 5. 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 F W <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. n ` <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. y '� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r Z_ C7 <br /> C p O <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. y <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 y' <br /> SETBACK AREA. Ull <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. F <br /> 7. annnnaoro <br /> t 1 <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my <br /> H <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all m d d a y <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this v C. D 9 to N <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I S R $ a= <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have <br /> access to the above-described Pmml7at <br /> nyreasonable time-.forthe purpose of inspection. >OWNER'S SIGNATUREv-L/ �"'A c o'. <br /> (date) r) <br /> /� J Q <br /> ZONING ADMINISTRATOR �10 � �CIVl(0)G(h 2 <br /> '� ���� w' cnh7 <br /> Sc <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATEPF ISSUANCE a N <br />