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c o <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator � <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER y �5 /�ej"�7� TELEPHONE <br /> MAILING ADDRESS �r�/ <br /> PROPERTY ADDRESS 7 �/y <br /> P � <br /> ' � o <br /> LEGAL DESCRIPTION <br /> r <br /> SINGLE FAMILY DWELLING O GARAGE/ACCESSORY STRUCTURE 0 ADDITION 0 STAIRS;e R ,� <br /> TYPE OF PERMrr(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ <br /> STRUCTURE/ADDITION USE: o P <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> �An6S .L/LTS <br /> BUILDING CONTRACTOR: 5 <br /> nC <br /> y <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. 71C ` o 5 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) n I d c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <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, y� <br /> AND INDICATE NORTH (N). I o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK E <br /> ti z <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. c <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 SOW AREAS TO BE GRADED OR FILLED. O �, <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE a. <br /> H 1 <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. \ n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. p <br /> n <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 <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY, <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. � � �3mbadtrorf <br /> 7. <br /> I 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 <br /> am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I further accept all ",N o y <br /> c Lo N$ N o t' <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 <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- s = <br /> described premises at any reasonabl for the rpo ins ctlon. ?+.2 3 .�. <br /> OWNER'S SIGNATURE > <br /> n ^ (date) <br /> o . <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED � <br /> `S <br /> w Sro <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE G^ <br /> �r✓hf �re�Po' ZAP bLy <br />