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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a UJ <br /> APPLICATION FOR LAND USE PERMITS o N <br /> 0 <br /> OWNER TELEPHONE a a <br /> sernar(-'l(e.r— <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS 3�_rkAm e) <br /> <, <br /> LEGAL DESCRIPTION c <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION 0 DECK GARAGE/ACCESSORY STRUCTURE ❑ .. � <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO0 STAIRS ❑ FILLING/GRADING 0 CAMPING UNIT ❑ <br /> t <br /> COMMERCIAL BUILDING ❑ COM�MpERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ c <br /> STRUCTURE/ADDITION USE: Ca! o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: n <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Ya X11 SHEET OF PAPER, ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS p g <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m ^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 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, c <br /> AND INDICATE NORTH (N). co <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 w <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. p O <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES q <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. m <br /> 5. 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. <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: r- OO S <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. C7 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ` `1 <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. CJS <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. > o 0 o n > 0 b <br /> " ' 3 33 9- <br /> 'Z n � ro goo ' <br /> I declare that this application(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 c. W m r w „ y <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this " ` > > m ',3 : <br /> Information I am providing will be relied upon by the County of Burraett Wisconsin In determining whether to Issue a permit. I g $w' > <br /> further accept all liability that may be a result of the County of Burrett relying on this Information 1 am providing In this <br /> app <br /> access tthe above-described premises lo ve_iofficials <br /> reasonablereaso ab einspection. <br /> hwith <br /> time for the purpose of insinances or other authorized person to have W = a W $ 8 n <br /> a <br /> � 's7 w y ggogg � <br /> OWNER'S SIGNATURE. - ^ /D >' y 7, O <br /> oR = !Z <br /> (date) <br /> ,T � �o" o= . s� <br /> ZONING ADMINISTRATOR V I / / (�0 Y1 :' R - <br /> 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIR OYEAR FROM DATE OF ISSUANCE = " <br /> Per-m1+ pICd � p 6y ONE,E' enary kelp �f �7-�c � � soo � s <br />