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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Adj iinistrator H — Z <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER ` TELEPHONE <br /> e <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION <br /> g <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION STAIRS ❑ Q �p- <br /> TYPE OF PERMIT(S): :. <br /> FILLING/GRADING ❑ CAMPING UNIT BUNKHOUSE ❑ 59.692(IV)GAZEBO❑ DECK ❑ I 4 <br /> STRUCTURE/ADDITION USE: <br /> Come/Cabin; Commercial Business; Bedroom; Deck; etc.) e <br /> BUILDING CONTRACTOR: L I <br /> A WILL BE RETURNED.PLOT PLAN MUST BE PROVIDED ON AN 8 yz X11 SHE OF PAPER. ANY INCOMPLETE OR ILLEGIBLE P OT PLANS I <br /> C <br /> F <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) C :5= <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. I^ p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTIING BUILDINGS/STRUCTURES (EB)AND ALL NE <br /> BUILDINGS/STRUCTURES (NB), INCLUDING D$CKS, PORCHES AND OTHER STRUCTURES, rs <br /> AND INDICATE NORTH (N). <br /> ai <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOW[ G: (A) BUILDING(S)TO ALL LOT LINES, (B) BU LDING(S) I <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEA %MENT(S)TO THE ORDINARY HIGH WATER MARK 3 <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WE LAND AREAS, AND(D)LOT DIMENSIONS. <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD(DF),AND ALL DI STANCES o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 5 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANN¢D AND SHOW AREAS TO BE GRADED OR FILLED C J = a <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, E C.,THE <br /> PLANS MUST BE SIGNED AND DATED BY THE DINNER. - <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DON WHEN ~ t <br /> NEEDED. .� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: O Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQlI�IREMENTS WITHIN 60 DAYS OF PERMIT. I-' Z a 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. " F <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARIE ALLOWED UNLESS SPECIFICALLY PERMITTED. n <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLiS, ETC.,ALLOWED WITHIN THE REQUIRED WATE R (,\ 1 <br /> SETBACK AREA. I I� <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAC E ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. F <br /> 6. <br /> 7. Zn ,^. 39F <br /> 3 S. c�~ aw <br /> I declare that this application(including any accompanying ached le)has been examined by me and to the best of my kn wledge <br /> and belief It Is hue,correct and complete. I acknowledge that I a responsible for the detail and accuracy of all informati in F _ <br /> contained in this application(including any accompanying scheduI )and I further declare that I recognize that this inform tion I i, D <br /> am providing will be relied upon by Me County of Burnett Wiscon n In determining whether to Issue a permiL I further a cept all g.< - <br /> liability that may be a result of Me County of Burnett relying on D Information I am providing In this application. I agre to a <br /> permit county officials charged with administrating county Praline m or other authorized person to have access to the stive- a I: f] <br /> described Premises at any reasonable time for the purpose of Inspection. c ` n:+N ='D <br /> OWNER'S SIGNATURE ^ n ^ $N z <br /> (date) E ,el <br /> ZONING ADMINISTRATOR _ M <br /> RS <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> N' N: <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> /Vy i Ie41eir l �0 Az rv, Kletd6i-) --Y-C» <br />