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Burnett_ County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS R z <br /> P � O <br /> 6 <br /> OWNE � <br /> u / �' TELEPHONE /�� Z o. <br /> ///WWW d2 _ v <br /> MAILING ADDRESS <br /> a , o <br /> PROPERTY ADDRESSZS Q <br /> LEGAL DESCRIPTION J <br /> (O CC-, v & �s <br /> SINGLE FAMILY DWELLING ARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ ST IRS ❑ 'o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADIN ❑ AMPING NIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DE K ❑ <br /> STRUCTURE/ADDITION USE: P 3. <br /> (Home :a i� Commercial siness; Bedroom; De k; etc.) cc <br /> BUILDING CONTRACTOR: bi <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. r, to <br /> O 3 <br /> z 2. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (gRIAL OR TOP VIEW) O 2. — <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 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, ` <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILD NG(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MAR <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. 3 <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DIST NCES w o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT EASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 5. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE <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 Vi HEN y <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <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. n z I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. n <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA, <br /> 5. ACCESSORY SED FOR HUMAN HA PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE NLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. � <br /> 6. <br /> 7, U -/K s 7j D�mODOS <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my know) ge <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information c ='_ <br /> contained in this application(Including any accompanying schedule)and I further declare that I recognize that this InformationI o ' 2 I <br /> am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further acceptall " v° i.+`—'» <br /> liability that may be a result of the County of Burnett relying on this Information I am providing In this application. I agree to <br /> permit county officials charged with admin acing county ordinances or other authorized person to have access to the above- <br /> described premises at any reasonable ti or the purpos of Inspectlo . A <br /> c 00 @O@ ^+T D <br /> OWNER'S SIGNATURE — � <br /> I (date) y . 6 n��Z <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> W 8NMo <br />