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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator c <br /> APPLICATION FOR LAND USE PERMITS & W <br /> .H � w <br /> O <br /> b <br /> OWNER TELEPHONE �- a <br /> MAILING ADDRESS 3 Ab/ id� <br /> / T7 <br /> PROPERTY ADDRESS V 2 /jam / _ <br /> LEGAL DESCRIPTION (7 <br /> DWELLING/BUILDING ❑ GARAG CCESSORY STRUCTURE f V ADDITION Cl STAIRS 13S CA <br /> TYPE OF PERMIT($): ,ry <br /> FILLING/GRADING ❑ CAMPING UNIT 13 BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ `D <br /> STRUCTURE/ADDITION USE: ��Q,Rt Q 'C� _ 2 �� <br /> (Home/Cabin; Co erclal Business; Bed <br /> room; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS I 91 <br /> WILL BE RETURNED. yy <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 9 � <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. t a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW ti <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, re w <br /> AND INDICATE NORTH (N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) W <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK Q 5 <br /> (OHWM) OF LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES P <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o <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 <br /> NEEDED. 91 5 < <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 8 n <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 <br /> SETBACK AREA. — <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. f <br /> 6. <br /> n � 9 W7YCJb <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge a ..,�a y <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information <br /> contained In this application(including any accompanying schedule)and I further declare that I recognize that this Information I <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to issue a permit I further accept all c Now o �y <br /> liability that may be a result of the County of Burnett relying on this Information I am providing in this application. I agree to <br /> permit county offldals cha :=strung county ordinances or other authorized person to have access to the above- S m <br /> described premises at any able time for purpose of In on. tz ?� O v,c c > <br /> SIGN HERE {�`' <br /> (signature of owner/or buI dlny contractor) (date) <br /> ZONING ADMINISTRATOR�/ I lm <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE.YEAR FROM DAT OF I UA CE r <br /> #�-eti/vy)7L f t l�1 fel/ y�L td �o bL.l 4A 61fh <br />