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M 0 <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS y. Z <br /> s <br /> n y/ , V <br /> OWNERiffy / TELEPHONE y`1��•3S _e <br /> `D O <br /> MAILING ADDRESS z 9179 �e /6rs' b r` <br /> PROPERTY ADDRESS A A o ) <br /> LEGAL DESCRIPTION o <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DEC GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ b } <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ c <br /> STRUCTURE/ADDITION USE: o O\ <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) S <br /> BUILDING CONTRACTOR: <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. Y P <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 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, S <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) Q <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, c) 0 <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES q ly <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. n' mCod <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE o 4__ <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> G G <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN �/) <br /> NEEDED. W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: C 6 j <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n L") � <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. !n 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. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. p <br /> 6. c <br /> 7. n 79 > nb] n <br /> G <br /> I declare that this application(Including any accompanying schedule)has been examined by me and M the best of my B 0,°7 <br /> knowledge and belief R Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all o, m m d <br /> Information oontalned In this application(Including any accompanying schedule)and 1 further declare that I recognize that this v a> > w ti > <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. 1 <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this v '�o :.,N'�-''_^r "0 <br /> application. 1 agree to permit county officials charged with administrating county ordinances or other authorized person to have o <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. ° mi55W N w n <br /> �yy 6 O W 0 0 <br /> OWNER'S SIGNATURE C t JX fj u.� r) yr > o m n o _ Off, <br /> _ (date) c 6 <br /> ZONING ADMINISTRATOR (m �Q n �[f` CIS [- 6 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> HIS PERMIT SHALL EXPIRE ONE YEAR FROM.wDAT OF ISSUANCE <br /> 4 �a941 <br />