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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator z <br /> APPLICATION FOR LAND USE PERMITS G� (� <br /> � n <br /> OWNER L TELEPHONE <br /> MAILING ADDRESS /lQ CY,)4 <br /> 6lll1 �(n� 0 <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE 0 ADDITION STAIRS ❑ o (� <br /> TYPE OF PERMrr(S): ,0 4 <br /> FILLING/GRADIPG❑ CAMPING UNIT O, BUNKHOUSE❑ 59. 92(1V)GA EBO DECK O � <br /> STRUCTURE/ADDITION USE: - z <br /> � (Home/Cabin; CBusiness; dro ; Deck; a".) <br /> ,r} o <br /> BUILDING CONTRACTOR: �/1lLj_:7 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS r' <br /> WILL BE RETURNED. < <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) o <br /> 6 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Inel <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW y n <br /> BUILDINGS/STRUCTURES (NE), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, m b <br /> AND INDICATE NORTH (N). _ <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK o <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. N r„ <br /> 4. SHOW THE LOCATION OF THE WELL(W) SEPTIC TANK (ST)AND DR4INFIELD (DF),AND ALL DISTANCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. W <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 E g <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> y AJ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN W w <br /> NEEDED. 00 b?�-- <br /> w <br /> THIS PERMIT IS SUB]ECi TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ' z a <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. o <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER d <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. r <br /> NOT TO BE USED FOR HUMAN HABITATION. f <br /> 6. <br /> gyaao a <br /> 7. <br /> 1 declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge <br /> and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information <br /> contained in this application(Including any accompanying schedule)and I further declare that I recognize that this Information I d, Y <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all <br /> liability that may be a result of the Co ty,o!Bum ng on this Information I am providing In this application. I agree to — 8 "'`" 8 t" <br /> permit county officials;charged with d Inistrating ceun ordinances or other authorized person Co have access to the above- o^ N <br /> described premises at any reason a time for the pure of Inspection. m C1 m T �__'. y <br /> OWNER'S SIGNATURE Cl b —0 •7 <br /> (date) ,y $ 5 c .� <br /> ZONING ADMINISTRATOR <br /> 8 < <br /> S <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS RMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> Odm/ � 4- le�*e- -fo Kay 10WOn 0l6 "(» <br />