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w ro Z <br /> � � o <br /> 6 � <br /> Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator 5 <br /> APPLICATION FOR LAND USE PERMITS V 1 <br /> OWNER TELEPHONE > O <br /> R s or, <br /> MAILING ADDRESS a C7 g(P� /4 r e ��u <br /> PROPERTY ADDRESS lcS�O c <br /> 50r <br /> LEGAL DESCRIPTION 0t I `f"e&_+A ✓reeoj /1 J/ f -J,, U. U. <br /> 7 <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ADDITION ❑ DECK GARAGE/ACCESSORY STRUCTURE ❑ 9 <br /> ro <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO ❑ STAIRS❑ FILLING/GRADING ❑ CAMPING UNIT❑ 0 3 <br /> COMMERCIAL BUILDING ❑ COMMERCIAL <br /> nADDITION <br /> a❑ COMMERCIAL ACCESSORY STRUCTURE❑ <br /> 0 <br /> STRUCTURE/ADDITION USE: WUeK04T1 <br /> o m;LOMmerctai pusmess; room; Deck;etc.) <br /> n <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vx X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLAITS � a <br /> WILL BE RETURNED. <br /> na <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW p o, <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH(N). I d Imo' Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)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. 5l) w 'j <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. C� o , <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1, ..Q <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. p <br /> vr' <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEII hv l N <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. UI f <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I G <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER 91 <br /> SETBACK AREA. O <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. SL <br /> NOT TO BE USED FOR HUMAN HABITATION. CJ <br /> 6. > > o �a <br /> 7. <br /> I declare that this application(including an accompanyingschedule has been examined b me and to the best of m A > �p N <br /> PP ( 9 Y ) Y YEr <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all '° a <br /> Information contained in this application(including any accompanying schedule)and I further declare that I recognize that this c 5 ^-00 <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I C1 <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am Providing in this 5 !; > <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized persan to have m 22 o o $ y <br /> access to the above-described pre t any monably time for the purpose of inspeRi n. y o 0 0 o H <br /> y nAt° Ra = z° <br /> OWNER'S SIGNATURE >� <br /> / Jr � �Ca : c <br /> (date) <br /> ( F� Fa� .n <br /> ZONING ADMINISTRATOR <br /> 1 � <br /> TOWNSHIP RM ITS MAY RE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> UU80000 <br />