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Burnett County 7410 County Road K, No. 102, Siren, WI 54672 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS N — <br /> OWNER YV�i/1 �I / ,nil �y TELEPHONE a o <br /> MAILING ADDRESS <br /> ab3rcf Sfi/ w mi�0r/hAj 6 W , <br /> PROPERTY ADDRESS /_i IIS/_ I• t�d p <br /> LEGAL DESCRIPTION c <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING 13 COMMIE^RCnIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> G <br /> STRUCTURE/ADDITION USE: 1 hlP <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) N <br /> BUILDING CONTRACTOR: <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 r//!X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. R <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) p <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. ^� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW m w 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, p 7? <br /> AND INDICATE NORTH (N). N W c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) p a 1 0 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 5 N <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. P [7 Q <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES C <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. rn <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o 0i <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE s <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 7Z) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> x <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. p n Z p <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. p " <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER 9J I <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, T n o 0 o ry a <br /> Z o n 3 3 <br /> I declare that this applicatlon(Including any accompanying schedule)has been examined by me and to the best of my 3 0 45 = P ? w <br /> knowledge and belief it Is true,correct and complete. I acknowledge that[am responsible for the detail and accuracy of all m <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this .° c_ D a m ,,, <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I n ?w' b <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 ° L.2 <br /> access to Me above-described-premises at any reasonable time for the purpose of Inspection. ° <br /> m CO mm <br /> . OWNER'S SIGNATURE <br /> (date) Ei <br /> Ei -- <br /> ZONING ADMINISTRATOR <br /> _16-) Fla n(yI.C(1 Ell <br /> O a wF t8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISS ANCE <br /> �2✓mI } 4- 1�f +exp p � Be ISS 6> tio000 <br /> c CI�P�d u <br />