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C O <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator o (J� <br /> APPLICATION FOR LAND USE PERMITS cncn hV <br /> N ( Ili N W <br /> 6 _ <br /> OWNER TELEPHONE <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS <br /> 0 <br /> LEGAL DESCRIPTION .`.• - <br /> SINGLE FAMILY DWELLING 0 GARAGE/ACCESSORY STRUCTURE 0 ADDITION 0 STAIRS 0 or. <br /> TYPE OF PERMrr(S): <br /> FILLING/GRADING�0 C�AMPIPING U AZE IT 0 BUNKHOUSE 0 59.692(1V)G0O I DECK C1 � g- <br /> STRUCTURE/ADDITION USE: l G'�U U) o <br /> (Home/Cabin; ommercial Business; Bedroom; Deck; etc.) > <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 ' X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PNS C 3 J <br /> h LA <br /> WILL BE RETURNED. o <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. bt <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 STRUCURES, <br /> AND INDICATE NORTH (N). Z- <br /> 3. <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) a <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. N <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TP.NK (ST)AND DRAINFIELD(DF), AND ALL DISTANCES <br /> TO BUILDINGS, ROADS,LAKE, LOT LINES. 1 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. uG o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE _ rU <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> , <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN IW O <br /> NEEDED. oS' <br /> , <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: 7� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. A o <br /> 2. REMOVAL.OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Q W <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. C' <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER 00 <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. T � >nw C > rV <br /> 7. 3'O 41 °E °e w' <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge <br /> and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information ,a o I Y <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information 1 v <br /> d �Y NN W N N <br /> am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I further accept all <br /> liability that may be a result of the C my of Burnett relying on this information I am providing In this application. I agree to n �c) o <br /> permit county officials charged col administrating county ordinances or other authorized person to have access to the above- m ti y m y <br /> described premises at any rea9llible time for ose of Inspection. Fj gg E g_ y <br /> i7 r�j '�-07 nA g� cnZ <br /> OWNER'S SIGNATURE 7 (date) 6 c <br /> ZONING ADMINISTRATOR v"� Ro(i( h �' ? <br /> � O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE "N 8 <br /> I�PVYv lelerrnaf0 Ku jNelsdh 3'0z <br />