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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Adminis rator z <br /> APPLICATION FOR LAND USE PERMITS a . <br /> a <br /> OWNER // TELEPHONE <br /> MAILING ADDRESS �3'fC.,O ns /,7.Lq <br /> PROPERTY ADDRESS71 <br /> y <br /> L ���- <br /> NO. �Z © Si J' PJJ.S� 2 /A/1 0 SE SQ to,J IN q <br /> % <br /> LEGAL DESCRIPTION Z' +�o<,n„I� 1,I•p r'o� Y �y o) Nor'H,, 2a,uge ro��TeeN C1`�)uJ es <br /> TYPE OF PERMIT(S): /T T,.,� <br /> C:UJN <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE/I_.,ADDITION ❑ STI "S11 <br /> FILLING/GRADING 13CAMPING UNIT❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DE K ❑ <br /> STRUCTURE/ADDITION USE: 1r z <br /> (Home/Cabin; C ercial Busines edroom; Deck; etc.) o ° <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS +� <br /> WILL BE RETURNED. O '� <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) mel <br /> a <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, ro <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILD NG(S) o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S) TO THE ORDINARY HIGH WATER MAR •d <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. o �' Z <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DIST NCES 5. 9 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. as <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. C7 c <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC. THE S. <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> y <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE HEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> r6i z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. W � <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n <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 /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE NLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> a40 'b <br /> 7. A <br /> I declare that this application (including any accompanying had has been examined by me and to the best of my know) dge m ` C <br /> and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and to <br /> of all Information p a= <br /> contained In this application (including any accompanying schedule)and I further declare that I recognize that this informati n I d c a <br /> am providing will be relied upon by the County of Burnett Wisconsin in determining whether[o issue a permit. I further acce tall 15- <br /> = ^(labilit <br /> y that may be a resuR of the Coun of Burnett rel in on this information i am rovidin ty Y 9 p 9 in this application. I agree[permit countyocalscharged with administrating county ordinances or other authorized person to have access tothe reetabovdescribed premises at any reasonable time for the purpose of Inspection.OWNER'S SIGNATURE �! CL/[.� 0(date) o D�ZONING ADMINISTRATOR 2 o6TOWNSHIP PERMITS MAY BE REQUIRED BURNS COILTHIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ZO INGo U o <br />