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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator z <br /> APPLICATION FOR LAND USE PERMITS a . <br /> N <br /> OWNER - <br /> C��t� TELEPHONE <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS � CA <br /> 2 <br /> LEGAL DESCRIPTION (/) <br /> o ti <br /> 55l5yl�sC7 <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE,M ADDITION ❑ STAIRS ❑ � c d ri <br /> TYPE OF PERMIT(S): � <br /> FILLING/GRADING ❑ CArMMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ .. <br /> STRUCTURE/ADDITION USE: f A-got-r�c /D,e� `j ��^ e ,. v ,er <br /> / <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; <br /> etc.) <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 +h X11 SHEET OFPAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) y <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. till <br /> O 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, tV.: nro <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) c <br /> TO CE (C)NTERLINE OF ROAD, BUILDING MEASUREMENT(S) TO THE ORDINARY HIGH WATER MARK <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 .�° N o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. t7 o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE " f <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 ti <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: tb i <br /> (e <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Z • <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. f9 A 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 /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. --�(,TIS �'Je.(' �- fVr 0- <br /> 7. <br /> Cl2Clc ek�anSlOn I.i7l�'h rDD'�Ovt �l� - <br /> EnCloslnc/� )s d ec-l� (orF+ �Sereev, or otG��w,ll re�u�re a pel rt g c ° d ° M <br /> _ -far Al ee l y o y 2 ro <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information I d 2 ^ Y <br /> am providing will be relied upon by the County of Burnett Wisconsin In dr!tertnlnlnq whether t Issue a permit. I further ecce all d "` i« <br /> liability that may be a result rN the County of Burnett relying on this information I am providing in this application. I agree t Pt P dk M o r <br /> permit county premises <br /> t charged with ad I'l lstratlnq county ordinances or other authorized person t have access t the above- o <br /> described premises at any rea noble for the purpose of Inspection. m <br /> OWNER'S SIGNATOR �ZAo o g 6 p <br /> M f (distill <br /> m <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED a <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE Og_ISSUANCE <br /> IZ 4t <br />