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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator P ° <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER a <br /> &)Ir)o I0j KU6( -i n TELEPHONE o <br /> MAILING ADDRESS ° <br /> �3gy Yn0 hensL/ <br /> PROPERTY ADDRESS <br /> g <br /> LEGAL DESCRIPTIONI -'�z + �c <br /> SINGLED FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ STAIRS ❑ Q <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CALMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ <br /> STRUCTURE/ADDITION USE: ` �L{,V � (,(, <br /> (Home/Cabin, CommemaI Business; Bedroom; Deck; etc.) z <br /> o <br /> BUILDING CONTRACTOR: <br /> n <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Ya X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLEPLOT PLANS O <br /> WILL BE RETURNED. V C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 1. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW C <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). 9 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) v <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. 5' <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 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. y W <br /> I� <br /> NOTE: BUILDING/STRUCRIRE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICA <br /> NEEDED. TION MY BE DONE WHEN <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. (7} <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 1�J1 <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER Z <br /> SETBACK AREA. a <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 /> F <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge m m O n O b <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information R ^ a a x c £ <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information I H 2 0 ° o E: <br /> am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all ? a <br /> liability that may be a result of the County of Burnett relying on this Information I am providing In this application. I agree to <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- <br /> described premises at any reasonabl time f r thZpurpo§E9 In OWNER'S SIGNAI� Lt�- <br /> m w npna _ > <br /> ate) m <br /> Mail t <br /> ZONING ADMINISTRATOR <br /> as <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> w o ��o <br />