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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g z <br /> APPLICATION FOR LAND USE PERMITS y y <br /> OWNER TELEPHONE o C,2J <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS �// L �/��J� C� r <br /> tll lQ C7� n <br /> 0 <br /> LEGAL DESCRIPTION /2)w YL CSG o ITI <br /> TE OF PERMIT(S): SINGLE-FAMILY DWELLING El ❑ DECK GARAGEd <br /> YP /ACCESSORY STRUCTURE �- <br /> m <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING ❑ C/OMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: .�TUY'G% S, ' <br /> (Home/Cabin; Comr6efcial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> � 3 <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yk X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. ,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. r• O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW ruf vo `% o <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, O 9 <br /> AND INDICATE NORTH (N). N z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) O <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. <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES f O <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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 WHENNEEDE13 ! ,.j <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. �) n Z f <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. 'A CNCN <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. T O <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. t' <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. sDoo om ao oC <br /> y 333 <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and bellef it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this E. a h m ! <br /> Information I am providing will be relied upon by theY <br /> County of Burnett Wisconsin In determining whether to Issue a permit. I a ,'�� 'n <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am provfding in this <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have <br /> access to the above-described premises at any reasons le time for the purpose of Inspection. <br /> j v aowwtiwy <br /> OWNER'S SIGNATUREX � <br /> (date) = Z <br /> ZONING ADMINISTRATOR \J 1 `� �-t w o^n R7 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATErsdMdi) '-. a <br /> LiurI F?Ti;crLI( Y <br />