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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNERo vv <br /> TELEPHONE <br /> a <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS / a <br /> n <br /> oV 1 <br /> LEGAL DESCRIPTION r <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION DECK ❑ c <br /> BUNKHOUSE ❑ 59.692(1V)GA2E60 ❑ STAIRS ❑ FILLING/GRADING 0CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ c C 1 <br /> STRUCTURE/ADDITION USE: ar ! /'' <br /> (Home/Cabin; C mmercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> O 3 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'k X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. .� y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) en O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. c m <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, a <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) J ° <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 5' <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (DF), AND ALL DISTANCES 3 W <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. (lJ <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. i <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. 7\� p0 93 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <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 C <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 /> 6. <br /> 7. aa° d <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 0 on A. <br /> knowledge and belief R Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all E. m d m E:a y <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this .'0 5. a a to <br /> Information I am providing will be relled upon by the county of Burnett Wisconsin in determining whether to Issue a permit. I <br /> further accept all liability that may be a result of the County of Burnett relying on this infornation I am providing In this <br /> application. I agree to permIt coca officials charged with adminLstrating county ordinances or other authorized person to have ^ m,°z <br /> accessto the above•desul p Ises at any rca ti the purpose of InspeNon. w B S u� <br /> l a� n <br /> — E 6 O W N O pp <br /> V � O.40pp0 <br /> OWNER'S SIGNATU — <br /> 9 _a m � ,,,.,� 2 <br /> ate O <br /> r1 H c.o' p� u <br /> ZONING ADMINISTRATOR v y� y(�j�, °= w °n <br /> ' Lt <br /> TOWNSHIP PERMITS MAY BE REQUIRED A "° <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE a «^N <br /> Ynv"­r1aie-"­r1 6/C. � �s000s <br />