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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator e o <br /> APPLICATION FOR LAND USE PERMITS g . <br /> S. m Wv <br /> V <br /> 0. <br /> OWNER 2 Y>'1 '✓S /� �) � J TELEPHONE7/ <br /> MAILING ADDRESS l/ 7 S � p� <br /> > y�o 5. �o� R(ve� Fc(Ils��oaa o <br /> � <br /> PROPERTY ADDRESS Q <br /> C.41'1 o <br /> LEGAL DESCRIPTION I—(/� I/� �s <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ STAIRS ❑ c S a <br /> TYPE OF PERMIT(S): _ ,o <br /> FILLING/GRADING C1 <br /> CAMPING UNIT❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ ti <br /> STRUCTURE/ADDITION USE: 57/)FN.../! P c (� <br /> (Home/Cabi ommercial Business; Bedroom; Deck; etc.) ' o y' <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 rh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS ' <br /> WILL BE RETURNED. ^rl� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) �j 0 a <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 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, M g' <br /> AND INDICATE NORTH (N). "I <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) n <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S) TO THE ORDINARY HIGH WATER MARK z a <br /> (OHWM) OF LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Y <br /> 4. SHOW THE LOCATION OF THE WELL (W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES r <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. ,��, '� p, <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 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. "n a J <br /> m � <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: c� <br /> 5' 9 <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Q <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER C <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 /> S >7. 2m W d y <br /> w <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information o o y <br /> contained In thls application(including an accompanyingschedule and I further declare that I recognize that this Information I g.. <br /> Pp ( g YB ) og <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all <br /> Ilablllty that may be a result of the County of Burnett relying on this Information I am providing In this appllcatlon. I agree to <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- 8 n <br /> described premises at any reasonable time for the purpose f Inspectlon. C v, N ?? y <br /> SIGN HERE 7— <br /> (signature <br /> — <br /> sl nature of owner or ulldln contfgctor <br /> ( 9 /� 9 ) (date) <br /> ZONING ADMIN RATOR �� tVl��V I(tiI� Z a� <br /> '� <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE S U o <br />