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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a 77 3 z <br /> / APPLICATION FOR LAND USE PERMITS r <br /> (� <br /> OWNER H r^ i/ O TELEPHONE �(0L — "?� <br /> C'�Fj 71-5 6 W <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION <br /> c <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ m <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION 'S <br /> ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> A <br /> ' J <br /> STRUCTURE/ADDITION USE: /' - <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: r �j O w. r ✓ h <br /> 'L� �{ <br /> r: I <br /> O ti <br /> i <br /> A PLOT PLAN MUST. PROVIDED ON AN 8'h X11 5HEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o <br /> WILL BE RETURNED. <br /> + c <br /> DIREC120N5 FOR PLOT PLAN DRAWING: (gRIAL OR TOP VIEW) <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, <br /> AND INDICATE NORTH (N). 5 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) I z <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK S <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. f0� <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. n ! <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE -i <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. z <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN I= <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: I� <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. v Z <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. I <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. £ <br /> 7. <br /> n n o c o n c O 7 <br /> m <br /> I declare that this application(Including any accompanying sdredule)has been examined by me and to the best of my <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all <br /> information contained In this application(Including any accompanyiInformng schedule)and[further declare that I recognize that this <br /> further <br /> acctionept <br /> I am providing will a relied upon by the County of Bu ng <br /> Wisconsin In determining Whether to issue a permit. I 4 c= E E D <br /> further accept all agree <br /> to liability that may county <br /> a result of the County of Bumett relying on this Information I am providing In this P `n .5 ., �, '9 <br /> access to t I agree cl permit county offata n charged blth administrating county ordinances or other authorized person to have la,7 w - 8 <br /> r <br /> access to the above-described premises at any reason time for the urpose of InspedJon, o 8 <br /> OWNER'S SIGNATURE t�l.f/LL-G!/�-- .16; /9 m ,�,o. � 'v <br /> (date nus <br /> >o s,^• py rz <br /> c :3 SFI <br /> ZONING ADMINISTRATOR m I Z § , <br /> . c y <br /> �v c <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ANCE 32009 <br /> u o v i w o <br /> B(J NIA OOOOO <br /> ZONING <br />