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z <br /> Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator < ' <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNERc a <br /> l tiC Ck TELEPHONE <br /> �-t <br /> MAILING ADDRESS <3 / /3 � Nd c f ��� <br /> CD U <br /> PROPERTY ADDRESSn ,, 0 I 1 <br /> r) 9 V 3 Pros/J �-}-� — <br /> LEGAL DESCRIPTION �Y b� I / 1� I UI G� e J �� LV Sear. Act f <br /> rr <br /> 0 <br /> 7� l l Pl¢oFPERMIT(s): SINGLE-FAMILY D D LUNG El ADDITION ❑ DEC GARAGE/ACCESSORY STRUCTURE ❑ � <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> 7 <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS 0 <br /> WILL BE RETURNED. <br /> 1I <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 c <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, CY <br /> AND INDICATE NORTH (N). c <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 c7 <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 5. O <br /> TO BUILDINGS,ROADS,LAKE, LOT LINES. t <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. b \ c <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. O�I�, <br /> C] <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. U� C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. W m z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ;n <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 /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. s � r'ai o Oo nc O 'O <br /> -. <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 6 <br /> 3 0 ,�„ w <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all y <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this E. y m e <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I w a c 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 <br /> application. I agree to permit county ofr 'als charged with administrating county ordinances or other authorized person to <br /> have access to the above-described p .-.- barged <br /> any ble ' e for he purpose of inspection. <br /> � � �,wwNwn <br /> OWNER'S SIGNATURE O y Z 0 0 0 0 0 0 <br /> (date) ^ fD '•2 O <br /> nd' co <br /> ZONING ADMINISTRATOR9 <br /> ' <br /> n, M <br /> rn <br /> TOWNSHIP PERMITS MAY BE REQUIRED I H <br /> d d � <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE o <br /> o : <br /> to to OOpp <br />