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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g 3 <br /> APPLICATION FOR LAND USE PERMITS <br /> � Q3 <br /> OWNER TELEPHONE X00 9—Z /7 ' <br /> a <br /> MAILING ADDRESS J �s�� ,lJ// � ✓�^^ V LtJT— G') s <br /> PROPERTY ADDRESS ��•�/ <br /> r <br /> LEGAL DESCRIPTION C w 1 i /�' F yL N L 3 5 73gN - 4� �g W <br /> TYPE OF PERMIT(S): SINGLLEE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE 1 ✓: <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ 7 <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: 1 r SE'I f Z <br /> (Home/Cabin; Commercial Busin ss; Bedro m; Deck; etc.) <br /> c <br /> BUILDING CONTRACTOR: <br /> i <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Va X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS z0 c_WILL BE RETURNED. r <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 y <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). I,` <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) ^S \I <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENTS)TO THE ORDINARY HIGH WATER MARK B p, <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 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. n. <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 i^ W <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. V I z U',1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN '.. <br /> NEEDED. <br /> THIS PERMIT i5 SUBJECT TO ALL CONDITIONS LISTED BELOW: 3 ' <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. x A <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. P <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. T F <br /> 7' S A ? O O O G > $ i`ql <br /> r � <br /> I declare that this appllcatlon(Including any accompanying schedule)has been examined by me and to the best of my g <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 accompanying schedule)and I further declare that I recognize that this 5 '> > <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I b <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this �C <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have � > <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. ° ' d w n <br /> C p N <br /> OWNER'S SIGNATURE d (date) >o 3 R v Z <br /> ZONING ADMINISTRATOR `' <br /> TOWNSHIP PERMITS MAY BE REQUIRED a O, ` v <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE y c` <br />