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C O O <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS 0 J <br /> OWNER TELEPHONE 651 - g3- 1-7Swil nsl <br /> s o <br /> MAILING ADDRESS 103, <br /> l�7IheexN'w, Io <br /> 1� CIM <br /> PROPERTY ADDRESS =D76Jnner 4 C <br /> LEGAL DESCRIPTION Z 3 a <br /> TYPE OF PERMTT(S): SINGLE-FAMILY DWELLING❑ ADDITIION ❑ DECK ❑ GARAGE/ACCESSORY <br /> STRUCTURE ❑ <br /> BUNKHOUSE O 59.692(1V)GAZEBO O STAIRS O FILLING/GRADING O CAMPING UNIT <br /> A <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: cab on �t "�I ' j` 6"-�Qr /S o <br /> (Home/Cabin; Commercial Business; B droom; Deck; etc.) <br /> BUILDING CONTRACTOR: y <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8%X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. n Y <br /> 6 (� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) o �- <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 trod <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). N o <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 Q <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. d 9)4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTANCES 3 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. n\ -_ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE I Y� o SU <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 <br /> NEEDED. I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: uJ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n 'Z G <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. C Q <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 5 <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. <br /> 6. <br /> >; ; ; > <br /> 7. <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 2 o <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all m <br /> Information contained In this application(including any accompanying schedule)and 1 further declare that I recognize that this E >> y <br /> Information I am providing will be retied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I m 5 m $w b <br /> further accept all liability that may be a result of the County of Burnett retying on this Information I am providing In this <br /> application. I agree to permit county oMdals charged with administrating county ordinances or other authorized person to have .2 8 8 80 .., <br /> access to the above-describedLet any reamnab me for the purpose of Inspection. 55YS o 0 0 8OWNER'S SIGNATU � ( (date) <br /> ap <br /> v >o s <br /> ZONING ADMINISTRAT 3f 1 J �F Uan I�Qn <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE I N o 0 0 8 <br /> ��(�- def m6 led .-fb <br />