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C O <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS H <br /> n Go <br /> OWNER )I/ r TELEPHONE <br /> O 00 <br /> Cn <br /> MAILING ADDRESS v O <br /> PROPERTY ADDRESS /,2DO ` dKc <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK 0 GARAGEJACCESSOKY STRUCTURE c 1 <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> COMMERCIAL BUILDING 0 /'COOMMERCII�AL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 <br /> STRUCTURE/ADDITION USE: `^"' yl���L)' o Cb <br /> (Home/Cabin; ComnWcjal Bus ss; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS � o <br /> WILL BE RETURNED. <br /> � n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) c <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 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, v <br /> AND INDICATE NORTH (N). N z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(5) o i o <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. p <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF),AND ALL DISTANCES CIQ <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w <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 713 E <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. /1�+ o 0I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN y <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: i— <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Z <) <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. B z G <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. `" I C> <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. ( n <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. R � > <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 ?'2 - n $ <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all ^ m $m o, y <br /> Information contained in this application(Including any accompanying schedule)and I further declare that I recognize <br /> that this �.D D m „`O, <br /> information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to issue a pemnt. I $ 5 n ?w.`r. rad <br /> further accept all liability that may be a result of the County of Burnett relying on s rmatbn I am providing In this b <br /> application. I agree to permit county officals charged with administrating countordlna as or other authorized person to have ^ O�° 0 8: $ $ <br /> access to the above-desalbed premia a ea�eforthose of Inspecilion. to 5 a o A W N A <br /> OWNER'S SIGNATURE o a g o <br /> �,/r r J ,(�-f�`(!i con W� o <br /> (date) c.N 9 woil <br /> ZONING ADMINISTRATOR y °� E w' : ' tM <br /> n L <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE H N <br /> " S" ,U <br /> o 0 0 $ <br />