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w <br /> o Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator ° <br /> APPLICATION FOR LAND USE PERMITS <br /> 0 <br /> OWNER Tom _ fC� /' TELEPHONE <br /> d <br /> MAILING ADDRESS f7 Q I QS 0)( ]4.1 ' <br /> 7 <br /> PROPERTY ADDRESS L <br /> LEGAL DESCRIPTION f( �-Mt 1 ,a1 Vl1, �o <br /> l�Hvi� 02-0- ¢333- 06aoo s .D <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ — <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING I% CAMPING UNIT LI <br /> 9 <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ o <br /> STRUCTURE/ADDITION USE: o Q <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> n <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 81/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. .� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. c O <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, b <br /> AND INDICATE NORTH (N). N 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 <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. p 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. 5. 09 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. W <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE o <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. I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: j C) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. r) <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Z Cj <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 <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. E <br /> 7. > <br /> ° 3 ° ry 6 t1I <br /> I declare that this application(Including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief It Is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of all g w A <br /> m � ; y <br /> Information contained In this application(Including any accompanying schedule)and I further declare that 1 recognize that this " w <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a pemrIt. I $ a w v 7 <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this ;,,s,: `�N 7 <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have 1' <br /> access to the above-describedpremises at any reasonable time for the purpose of Inspection, r 8 iA 0 0 8 y <br /> OWNER'S SIGNATURE W ��+L-a.� �b `dg `° °'a <br /> �dy <br /> (date) <br /> ZONING ADMINISTRATOR 010-) F I.Ct.O t Q'a c, `� `; ° w : e n M <br /> TOWNSHIP PERMITS MAY BE REQUIRED O °° <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE Q ti o p <br /> U O O O O p <br />