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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a 3 <br /> APPLICATION FOR LAND USE PERMITS = «' <br /> OWNER ) TELEPHONE <br /> �0f7 { J ?) o Z I < <br /> d <br /> MAILING ADDRESS 4- <br /> Z_—/y 5-4 Z//, C A <br /> PROPERTY ADDRESS <br /> LlJ 2hS 7— <br /> LEGAL <br /> LEGAL DESCRIPTION T r (')n <br /> TYPE OF PERMTT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK Cl GARAGE/ACCESSORY STRUCTURE ❑ V-1 <br /> ti _ <br /> BUNKHOUSE Fl- 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ �. <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ r' <br /> STRUCTURE/ADDITION USE: C4 V1 <br /> m <br /> C <br /> (Hoe/Cabin; Co mercial Business; Bedroom; Deck; etc.) � J <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. .� <br /> 'n n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW sf v 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, �� o <br /> AND INDICATE NORTH (N). - Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) 0 °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. U J, <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 SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE o �� <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. S <br /> i <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <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. ); <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 /> 7, ^ � an��oaoro <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 0,°2 <br /> knowledge and belief It is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of all pp m d d rn y <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this t_D D m T <br /> information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to issue a permit. I n R nw=: Y <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have 8 <br /> access to the above-described premises at any reasonable time for the purpose of inspection. <br /> OWNER'S SIGNATURE <br /> O <br /> (date) <br /> �(` ny d, a <br /> ZONING ADMINISTRATOR / I �� FlI-X y���1 Ct!"7 <br /> nt� <br /> cw' <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ti " <br /> (vi , c <br /> 4 <br />