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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a ( , W <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER U CA <br /> j TELEPHONE <br /> MAILING ADDRESS aO`l'8 o) <br /> PROPERTY ADDRESS <br /> all ll l s�SGt 1 <br /> LEGAL DESCRIPTION <br /> j�- <br /> TYPE OF PERMIT(S): SINGLE FAMILY DWELLING 0 GARAGE/ACCESSORY STRUCTURE4 ADDITION-OSTAIRS 0 <br /> FILLING/GRADING 0 RICAMPING UNIT O �BUNKHOUSE O 59.692(1V)GAZEBO 0 DECK O <br /> r rL- C� <br /> STRUCRE/ADDITION USE: IA 1 n <br /> (Home/Cab <br /> )T in <br /> /; <br /> ±Co ercial Business; om; Deck; etc.) 2 <br /> BUILDING CONTRACTOR: I, I P (� <br /> h <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Y:X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O <br /> WILL BE RETURNED. a � <br /> DIRECRONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. r1 I a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW C C <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, '� c <br /> AND INDICATE NORTH (N). 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) p <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM)OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D)LOT DIMENSIONS. 5' <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPRC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES p O <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. - Ct Do <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE 3 rn <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MYBE DONE WHEN <br /> NEEDED. J <br /> THIS PERMIT IS SUBIECr TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. W <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. <br /> 01 <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER z � <br /> �" C <br /> SETBACK AREA. P1 d <br /> S. ACCESSORY STRUCRIRE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAG <br /> 6. E/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 7. <br /> F <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge s m <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information 9 ^ C <br /> contained in this application(Including any accompanying schedule)and I further declare that I recognize that this InfoA <br /> mwtbn 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 y e N? P w y <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 0 <br /> Permit county officials charged with administrating county ordinances or other authorized person to have access to the above- $ <br /> described premises at any reasonable time for the purpose of Inspection. <br /> � NNNNpN y <br /> OWNER'S SIGNATU <br /> (date) <br /> a .. <br /> ZONING ADMINISTRATOR '/ H $ L O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> C <br /> MSN <br />