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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 y y <br /> OWNER n <br /> TELEPHONE e <br /> �c� L�� or 9�2-tao-o32-t+ <br /> m <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS () <br /> 3 y3S- rv�r s ��df� •n 1 <br /> LEGAL DESCRIPTION �- <br /> Io_ <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ r \) <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> Ill <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ c <br /> STRUCTURE ADDITION USE: H K� y c <br /> STRUCTURE/ <br /> (Home/gn C V. cial Business; Bedr m erc.) <br /> p ') r � <br /> BUILDING CONTRACTOR: <br /> -7/64, <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C 0 <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) M <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C m0 <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, R <br /> AND INDICATE NORTH (N), N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) o <br /> TO CENTERLINE OF ROAD, (C) 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 9 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. ti <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN — y <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: lS, r^ <br /> I � <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. I 8 a <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. (_nI <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. d <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> r- OLY4,)Y_G 4dal4°' meeyI <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 0 S <br /> knowledge and belief R 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 .°° E. > > m N <br /> Information I am providing will be relied 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 information I am providing In this g 5%-- <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have ° ° ''' r <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. E� <br /> tl > g o y <br /> OWNER'S SIGNATURE <br /> Q. <br /> v=i <br /> ZONING ADMINISTRATOR '6� y c° w H 6C) M <br /> TOWNSHIP PERMITS MAYBE REQUIRE <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE 0090111IMICOUNTY z,`-'N«« '=' <br /> ZONING " " 000. 8 <br />