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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a 9 z <br /> APPLICATION FOR LAND USE PERMITS <br /> 7 <br /> OWNER c J <br /> m r)7r o ( i 1 TELEPHONE d <br /> au <-i S_s_ 9a ?U v <br /> MAILING ADDRESS O <br /> -- IfSn " o- ,/roo /ova l S) % /YIIIJ t`S"Ilrf <br /> PROPERTY ADDRESS s -� <br /> n <br /> 0 <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S). SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ Ch <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ o rt <br /> STRUCTURE/ADDITION USE: C7a,/qo Q – &4n ' <br /> y <br /> (Home/Cabin, Com mErcal Business; Bedroom; Deck; etc.) I^ <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS ;_0 <br /> o t <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <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, (� 5 <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) ,(� <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. °a O C, <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES n <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. _ <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 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. I <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MYBE DONE WHEN i <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ' (7 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n z <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. — J <br /> S. ACCESSORE USED Y STRUCTURE/GARAGE PERMITS ALLOW <br /> /FOR PPRRIIVAQT"E RESIDENTIAL GARAGE/STORAGE ONLY. <br /> 6. NOT <br /> N. <br /> :SL b�� UCI,r-(a -Q <br /> F <br /> 7. y <br /> c � n Bo 0 o C d 0 7 <br /> H y333 � =- SS <br /> I declare that this belief <br /> It is cru (including any accompanying schedule)has been examined by me and to the best of my <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(Including any accompanying schedule)and I further declare that I recognize that this to <br /> `.a <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I a Y <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this c <br /> ° vo <br /> application. 1 agree to permit county officials charged with administrating county ordinances or other authorized person to have C, <br /> access to the above-described premises at any reasonable time for the purpose of inspection. <br /> Zi <br /> oowooa <br /> OWNER'S SIGNATURE �y El A a o 0 0 o 3 <br /> C ° 6 <br /> (date) �rc <br /> ZONING ADMINISTRATOR 'oTOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />