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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administlrator z <br /> APPLICATION FOR LAND USE PERMITS a �. <br /> OWNER i TELEPHONE c <br /> t'"") J <br /> MAILING ADDRESS <br /> W� Qq- <br /> PROPERTY ° <br /> ADDRESS © e( <br /> LEGAL DESCRIPTION <br /> <° w <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ STA RS)e o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DEC ❑ b � <br /> STRUCTURE/ADDITION USE: /UO I ,�( <br /> (Home/Cab ; Commercial Business; Bedro (� o <br /> . <br /> I � <br /> BUILDING CONTRACTOR: pl 5) <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT LANS <br /> n <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) � <br /> � 6 � <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. ,� p <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, 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) n <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. N o <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. Ei <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ill ^I Q <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., HE q ^ <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE W EN <br /> NEEDS <br /> NEEDED.. I �1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> z q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. � I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 9 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. \/fl <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE OLY, <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> roa�moro <br /> 7. axAyaaya � � <br /> I declare that this application(Induding any accompanying schedule)has been examined by me and to the best of my knowle i5 E <br /> C a <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information ge <br /> contained in this applicatio (Incljampanying schedule)and I further declare that I recognize that this Information I w a <br /> am providing will be relied ponf Burnett Wisconsin In determining whether to Issue a permit. I further acce all s+`—^'^®+N w <br /> liability that may be a resul ofmett relying on this Information Iam providing In this application. I agree to c -Vpermit[ounry offl[lals cha en county ordinances or other authorized person to have access to the above-described premises at any urpose of Inspection.OWNER'S SIGNATURE Ky S/, (date) >20NING ADMINISTRATO r I in <br /> < : °o <br /> TOWNSHIP PERMITS MAY BE REQUIRED v <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE v U o o <br />