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O O O <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS N <br /> OWNER TELEPHONE <br /> IlrCiv✓l �u5a� Dl LC <br /> MAILING ADDRESSaLd <br /> - i <br /> PROPERTY ADDRESS O A = s) C_ <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE4 y4 <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURED <br /> 0 <br /> STRUCTURE/ADDITION USEiome/Ca' �rtial Business; Bedroom; Deck; etc.) I to Q <br /> BUILDING CONTRACTOR: v <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o ` <br /> WILL BE RETURNED. = <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING (ARIAL OR TOP VIEW) r <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 m m ='' 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S) TO ALL LOT LINES, (B) BUILDING(S) ,°� o, <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK c N <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. p fad <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES 6 w <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. ri t s <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 o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. J <br /> �`v W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> �) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <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. B z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. d <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER N PIS <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. O lUi <br /> NOT TO BE USED FOR HUMAN HABITATION. �� £ <br /> 6. <br /> 2. a o 0 o d d ° bo <br /> n ^n 333 ,N, do M't? <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. 1 acknowledge that I am responsible for the detail and accuracy of all <br /> g P Po cY <br /> infortnatlon contained in this application(including any accompanying schedule)and I further declare that[recognize that this E. D Y aO <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I d , b <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing in this c y yr:n'—=„"'; b . <br /> ns <br /> application. I agree to permit county officials charged wi istratIng county ordinances or other authorized person to have <br /> access to the above-described prem s s at any.season le time f the purpose of Inspection. m ti w w n o <br /> a /s ii = � d >`� oo � oy <br /> OWNER'S SIGNA — d <br /> 0 <br /> rt a d <br /> (date) <br /> 2 0 �a.N !!'P-� ' ia7S <br /> ZONING ADMINISTRATOR y p� y F S : T c <br /> 8 0 <br /> TOWNSHIP P RMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE Y R FROM DATE OF ISSUANCE N o o <br />