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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator E <br /> APPLICATION FOR LAND USE PERMITS a G, <br /> OWNER / _ �...�" �7- TEF,EPHONE ^I c (,_ 'a C�S O <br /> MAILING ADDRESS .- <br /> R /rte <br /> PROPERTY ADDRESS , I�6 I I I NP-1 I S� 1 `C.� v RAPt5 C u �� -I <br /> �N N fV O <br /> LEGAL DESCRIPTION o <br /> TYPE OF PERMIT(S): SINGLE-F DWELLING 0 ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTUR 5 <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 ,g <br /> v <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 0 <br /> STRUCTURE/ADDITION USE: r n P <br /> 0 <br /> (Home/Cabin mmercial B siness; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: w <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN B Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS c _ <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) M d <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 9 ° <br /> 3 <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). o 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDINGS) <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. O <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTANCES - <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. W <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE W <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 y w <br /> NEEDED. C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: w 0�1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. r) z 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. K a w <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMMED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER _ d <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. <br /> 7 aro <br /> � n n °x5q533 nn � <br /> I declare that this application(Induding any accompanying schedule)has been examined by me and to the best of my g e q ;,,2.L.� <br /> knowledge and belief It Is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of all 6. m a $e.i, "3 <br /> Information contained in this application(Including any accompanying schedule)and I further declare that I recognize that this n n a <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I m - y ?w 5 H y ro <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this c c H N: N ro <br /> application. I agree to permit county off cia charged WIN administrating unty ordinances or other authorized person to have '.4 g$ $$ r. <br /> access to the above-described p at n reasonable ti for the pu ose of Inspection. 3 ^ >8 c c c$ y <br /> _ _ 0 � <br /> OWNER'S SIGNATURE (date) <br /> ZONING ADMINISTRATOR an <br /> TOWNSHIP PERMITS MAY BE REQUIRED d <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE t2 <br /> �� 8000$ <br />