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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator n z <br /> APPLICATION FOR LAND USE PERMITS d <br /> U� <br /> y N <br /> n � A <br /> OWNER eV"l nr�/T�/1� TELEPHONE`S/—�7S� <br /> MAILING ADDRESS <br /> •j o D [.�/T v ? P /r, 0� 1 E <br /> PROPERTY ADDRESSQ(6 <br /> LEGAL DESCRIPTIONLO1 1,2- /�L4P)ce1/!� Q��— /O�^OJ ��C7 C o C�T <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE 19 ADDITION ❑ STAIRS ❑ _ 3 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT D BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ ^' <br /> STRUCTURE/ADDITION USE: z <br /> C (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) P <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PIANS r <br /> WILL BE RETURNED. O 3 <br /> A <br /> c_ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) +Ci <br /> � LY <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. tnf O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW ^—r• <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, m ,� <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) c <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 93 <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. N <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTANCES w o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. Q <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. lug c (N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE — d <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 <br /> NEEDED. O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: f <br /> r O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Zz �• <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 (fl <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. E <br /> 6. <br /> 5 x > > -V <br /> 7. r^�r ni:a_s <br /> coo 1 ° o <br /> w ° <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge 3 <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information o 2 <br /> contained in this application(including any accompanying schedule)and I further declare that I recognize that this information 1 E » > <br /> am providing will be relied upon b the County of Burnett Wisconsin In determining whether to Issue a permit I further accept all <br /> P 9 P Y ry 9 P P c(,1ie �N <br /> liability MBurnett relying may be a result of the County of Burnrelying on this Information I am providing In this application. I agree to WO�S F5 r <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- 6 � fl <br /> described premises at any reasonable time for the purpose of Inspection. 'o > <br /> OWNER'S SIGNATURjl�/ '�y% <br /> (date) ' H ' 0 6 > <br /> Q �s�w tr1 <br /> ZONING ADMINISTRATOR V 1 m F/9 I ai q, <br /> TOWNSHIP PERMITS MAY BE REQUIRED O <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE 8 o <br /> P a•-rg-og <br />