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c n Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER / TELEPHONE 7D�.D d J <br /> MAILING ADDRESS <br /> o <br /> PROPERTY ADDRESS •`i7 !� ,'`�C/'", w <br /> LEGAL DESCRIPTION R c <br /> �j4/—/LAV �c� �r, <br /> 12 -5#0 IZs - Lor <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION D DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ 5 (0 <br /> d <br /> BUNKHOUSE ❑ 59.692(IV)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE <br /> STRUCTURE/ADDITION USE: L jJ i Y y <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) ' \ <br /> BUILDING CONTRACTOR: 4. <br /> 41 <br /> y <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 V2 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) a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C F <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, 3 E <br /> AND INDICATE NORTH (N). N Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) <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 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. - I <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. ! C�_ 3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. -a v l <br /> i <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r <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. 8 LY <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 'o Q <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <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. ' 33 $ [E <br /> I declare that this application(Including an accompanyingschedule has been examined b me and to the best of m $' <br /> PP ( 9 Y ) Y Y <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all <br /> Information contained In this application(includ any accompanying schedule)and I further declare that I recognize that this " D D m `D <br /> Information I am providing will be relied u the County of Burnett Wisconsln In determining whether to Issue a permit. I m 5 $w- 7 <br /> further accept all liabilit4mat <br /> he County of Burnett retying on this Information I am providing In this c � rn b,: :N b <br /> application. I agree to rged with administrating county ordinances or other authorized person to have $ $ t" <br /> access to the above-desasonable a for the purpose of Inspection. 5 8 w u'A"OWNER'S SIGNATU O Z d jate) er <br /> ZONING ADMINISTRA <br /> t-1e <br /> ((nn� <br /> ^I <br /> TOWNSHIP PERMITS MAY BE REQUIRED A C�i <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ° > <br /> pl/Md- 1-w ptc-e-ea� uehvFa e,)ztoe; � <br />