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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS G� <br /> y/ y <br /> OWNER �I, '1fJi � �-� •y�pi/ ./ Fh J/ TELEPHONE <br /> MAILING ADDRESS 33r7Lf // /n-{-!_ �1— (�..�, /„�( � y, '}l 5 I <br /> PROPERTY ADDRESS <br /> C) <br /> LEGAL DESCRIPTION a5r), (/ <br /> TYPE OF PERMIT(S): SINGLEE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ v� <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT., <br /> v <br /> COMMERCIAL BUILDING ❑ /COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: n <br /> A PLOT PLAN MUST BE PROVIDED ON AN 6 rh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. c o, <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, a <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) ° <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. �p 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. I <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 /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN ) N� <br /> NEEDED. 47- <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: C> <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Y <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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 1 rn C <br /> SETBACK AREA. I " <br /> S. 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 X333 $^ IMy <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belle(It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all o, m <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this a c, > > m <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I <br /> further accept all liability that maybe a remit of the County of Burnett relying on this Information 1 am providing in this c (F <br /> application. 1 agree to permit county officials charged with administrating county ordinances or other authorized person to have ^ �,°2 0 0 : g 8 rr. <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. <br /> aogoo8y <br /> OWNER'S SIGNATURE-� �17 ' 'm n <br /> � yao� dR � _= z <br /> (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THI PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE «"� " <br /> ��'m, �� � <br />