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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of zoning Administrator P ° <br /> APPLICATION FOR LAND USE PERMITS `J� <br /> OWNER <br /> a <br /> TELEPHONE a Q <br /> MAILING ADDRESS ,t Q —fir I <br /> PROPERTY ADDRESS ^:h /� q ` 1 <br /> LEGAL DESCRIPTION c J <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ADDCTION ❑ STAIRS ❑ I^ <br /> TYPE OF PERMIT(S): k <br /> FILLING/GRADING 0 CAMPING UNIT 0 BUNKHOUSE 0 59.692(1V)GAZEBO 0 DECK 0 <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business, Bedroom; Deck, etc.) z - <br /> BUILDING CONTRACTOR: I P <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz 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) y <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. M o. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW C m� <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, b c <br /> AND INDICATE NORTH (N). B <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) v <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. <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES p <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE y <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. y <br /> 0 <br /> W <br /> NOTE: NG/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDS <br /> NEEDED. Vv <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: y n' <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. <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 Z <br /> SETBACK AREA. r <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. I� J <br /> NOT TO BE USED FOR HUMAN HABITATIOf11 C <br /> 6. O <br /> 7 <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge o D c tJ a 'O <br /> and belief R Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information R ^ n <br /> contained In this application(including any acoompanying schedule)and I further declare that I recognize that this inforrnatlon I y Z <br /> am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all 2 ° Q C <br /> liability that may be a result of the County of Burnett relying on this Information I am providing In this application. I agree to m"'o <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- '$ g 2 <br /> described premises at any reasonable time for the purpose of Inspectlon. <br /> OWNER'S SIGNATURE <br /> to f) <br /> (date) e <br /> 1 oH : ewa °z <br /> ZONING ADMINISTRATOR I/�'IS 5 <br /> Eu me > - <br /> o _co 'r1 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> N p N N N <br /> Ib- !s-off <br />