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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator a T z <br /> APPLICATION FOR LAND USE PERMITSy o <br /> < W <br /> OWNER <br /> TELEPHONE e a <br /> MAILING ADDRESS P. D B D X '30 V\,) e '54 8 / (� V <br /> PROPERTY ADDRESS 85 N &Ss L_a L e fed \ S <br /> LEGAL DESCRIPTION <br /> o � � <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLINGX ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE 0 w <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO ❑ STAIRS❑ FILLING/GRADING❑ CAMPING UNIT❑ 5. <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ <br /> ! I M <br /> S <br /> STRUCTURE/ADDITION USE: o f 1 e I z <br /> (Home/Cabin;Commercial Business;Bedroom; Deck; etc.) / c <br /> BUILDING CONTRACTOR: --�"1��N <br /> ti <br /> A WILL BE RETURNED,PLOT PLAN MUST BE PROVIDED ON AN 8'/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS c W <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) C I a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. t7 <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, a' &I 3 <br /> AND INDICATE NORTH(N). '? <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B)BUILDINGS) o o <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK '- w <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 O �- <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 I� c <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 AJ <br /> NEEDED. X11 -j <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: SO I <br /> r (e <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. yZ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. X C <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER S C) <br /> SETBACK AREA. C/ <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. s > 0 0 o n > O <br /> m E <br /> Fm n ry o o <br /> I declarethat this application(including any accompanying schedule)has been examined by me and to the best of my knowledge g ,�8 <br /> o <br /> and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information E. d— d— d e <br /> o — c <br /> contained in this application(including any accompanying schedule)and I further declare that I recognize that this information I .� '5. > > <br /> am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I further accept all �a " a <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 C> 'e^ 7 <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- o Chi $ =� '�' o <br /> described premises at any reason time for the purpo of Inspection. O S `� 8 8 iOil <br /> g Q <br /> OWNER'S SIGNATURE r fD > w � <br /> (date) <br /> ZONING ADMINISTRATOR J 1 fl'� F L Q V1- �►g n ,� <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE C N �;22 <br /> P"M_t u/061 Ca/son /JanI���/, �� aso00 <br /> 8 - ia�o8 <br />