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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER TELEPHONE CCl1� <br /> 1 - ay7 -1 t) <br /> MAILING ADDRESS <br /> ya.?v cJEs7b,v <br /> l <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION T 0&I 2(�O L(f -r . ,�.j-7 CSN <br /> TYPE OFPERMrr(s): SINGLE-FAMILY DWELLING ❑ ADDITION DECK ❑ GARAGVE,/ACCESSORY STRUCTURE ❑ ti <br /> BUNKHOUSE ❑ 59.692(IV)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ S' <br /> STRUCTURE/ADDITION USE: j}T <br /> (Home/Cabin• Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: J <br /> n G <br /> A PLOT PLAN MUST BE PROVIDED ON AN 6 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C 0 <br /> WILL BE RETURNED. _ <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) C4 a C, <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 c <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 5 <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) y <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 5' s, <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. G �; <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. ly q <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. i <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. rj LV <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> r ` <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> I� n <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER (� <br /> SETBACK AREA. .� <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. :e7. <br /> ^ 70aoa � � <br /> n R 3 3 3 � <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my c o o'o' <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all o, ? oo <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this `° `W D 9 W m <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I d <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing in this ,. R H in <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have o �n <br /> access to the above-described premises at any reasonable time for theu <br /> p rpose of Inspection. S (� <br /> y�_ 3 Kf a 9Sg000 'i <br /> OWNER'S SIGNATURE <br /> ( at ) � 0 6e6j. m Q6 , <br /> R r ►y/aZONING ADMINISTRATOj .y� -F—I <br /> � 17 <br /> � 1H <br /> S <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> ,�HIS PERMIT SHALL EXPIRE ONE YEAR FROM D TE OF ISSUANCE <br />