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C n p <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER TELEPHONE d <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION cfIU)a d baa ( <br /> JONIhLI12:St SPt'ridU .?ie �d0 1 (�luCs <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK O GARAGE/ACCESSORY STRUCTURE w <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> v <br /> COMMERCIAL BUILDING COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE C3S' <br /> STRUCTURE/ADDITION USE: rn fV1(Aq o <br /> (Home/Cam;Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR:. i S, I&a4 ) � <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m �y <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, E <br /> AND INDICATE NORTH (N). N z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S) TO ALL LOT LINES, (B) BUILDING(S) g 'off <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. O <br /> 4. SHOW THE LOCATION OF THE WELL (W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES y O <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <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 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> i <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: I <br /> x <br /> m <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. � <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. E -L <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. E <br /> 6. <br /> 7. s � � 000 � cf�ry <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my B o <br /> knowledge and belief It 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 `° °. a 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 °' c avo v `a0 <br /> further accept all liability that may be a res of the County of Burnett relying on this information I am providing In this <br /> application. I agree to permit county offl als charged with administrating county ordinances or other authorized person to n °= : o : o o t <br /> have access to the above-described pre ises at an time for the purpose of inspection. ° in a > <br /> fo �' <br /> A <br /> 3„ rt c o <br /> OWNER'S SIGNATURE /d <br /> (/ (date) 0 y, a <br /> ZONING ADMINISTRATOR �J I (Y1 Han <br /> TOWNSHIP PERMITS MAY BE REQUIRED y <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE g <br /> �.r N 69 69 f5 O <br /> � tNn 000 00 <br />