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b <br /> a <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator H N <br /> APPLICATION FOR LAND USE PERMITS <br /> P� neV a <br /> OWNER al vJ y TELEPHONE <br /> r � <br /> MAILING ADDRESS y <br /> PROPERTY ADDRESS A L <br /> LEGAL DESCRIPTION <br /> s G. ✓ �� L� .G L. � / �s��.L.LC,j �l'"G' .)LA/.L,9'/ w <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK❑ G�E/ACCESSOR�RUCTURE2 <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> r � <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ <br /> z <br /> 0 <br /> STRUCTURE/ADDITION USE: - <br /> (Hoin; Com rciel Business; Bedroom; Deck; etc.) qj <br /> SCJ n � <br /> BUILDING CONTRACTOR: <br /> 3 <br /> � o <br /> A PLOT PLAN MUST BE PROVIDED ON AN B 1/2X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. n ii <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. :n �- <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, 1 N 1 a <br /> AND INDICATE NORTH(N). �. o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGG S)TO ALL LOT LINES,(B) BUILDING(S) CD <br /> CD <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(5)TO THE ORDINARY HIGH WATER MARK I <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. Pj O <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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR,ETC.,THE <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN �)J <br /> NEEDED. p <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. d z <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 C) <br /> SETBACK AREA. O <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> >yaat <br /> 7. <br /> z A O O o o t a m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 F <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all K. <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this O D W N <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this <br /> application. I agree to permit county officials charged with administrating county ordinances or other orized person to <br /> have access to the above-descritl pyemises at any able_tf9{e for the purpose of in f'on. " 6_+d'w o o y <br /> OWNER'S SIGNATURE �'� -`Z2 �Z "u ECERVE <br /> /,..., (date) rUN <br /> 65 a� W n ty _ 0 <br /> ZONING ADMINISTRATOR 01 o " a t <br /> N as <br /> Ac : P5 <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURNM COUMy <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ZONING <br /> tJivNi O O p O O <br />