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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER rR ✓'II " I�il I/� TELEPHONE l 15 'S S J-Vq ZI -- c <br /> LA, 0 <br /> MAILING ADDRESS ( 2- b <br /> PROPERTY ADDRESS + (x r3 <br /> 's <br /> LEGAL DESCRIPTION 1 L:�o -713-2A/ <br /> - , / r)1, / V� <br /> TYPE OF FERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE = H <br /> BUNKHOUSE 0 59.692(1V)GAZEB0❑ STAIRS❑ FILLING/GRADING❑ CAMPING UNIT 0 <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE 0 <br /> 7 <br /> STRUCTURE/ADDITION USE: C Ir,!dw (Home/Cabin; Commercial Business; BetlrOam; Deck;etc.) - � <br />^--BUILDINGCONTRACTOR:- - - - - y <br /> z <br /> AP LOT PLAN MUST BE PROVIDED ON AN R'/z XII SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> n <br /> DIRECTIONS FOR PLOT PIAN DRAWING: (ARIAL OR TOP VIEW) r <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. O - <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, \ -' <br /> AND INDICATE NORTH(N). WWW z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(B)BUILDING(S) L <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. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALC 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. W c 1 r <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. I / <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN 0 T I <br /> NEEDED. C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 4 V C <br /> 2: REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE, a l <br /> 3, NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 9,_NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER _ - ,p. <br /> �- SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. a <br /> NOT TO BE USED FOR HUMAN HABITATION. 5 <br /> 6. <br /> 7. A > nr, n : > yp <br /> I declare that this application(including any accompanying schedule)has been examined by me and on the beat of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that l am responsible for the detail and accuracy of all <br /> information contained in thisappf tion(including any accompanying schedule)and I furtherdeclare that I recognize that this 7 _ D <br /> information 1 am providing will he relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 5 <br /> further accept all liability that may be a result of the county of Burnett relying on this information l am providing in this <br /> application. l agree to permit county officials charged with administrating county ordinances or other authorizetl person top11� - c - - <br /> have access to the above-described premi sat any reasonable time for the purpose of inspecti V s� _ =u (1 <br /> OWNER'S SIGNATURE •/��/ A��1�/ �� V ' -' <br /> (dot >.J <br /> ZONING ADMINISTRATOR "�� -` SEP 2 3 2013 <br /> OWNSHIP PERMITS MAY BE REQUIREDBURNETT COUNTY <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCIZONING <br />