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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator v z <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER DA �# Or �5 TELEPHONE J� ���� n(j�� �• <br /> MAILING ADDRESS ® �� and <br /> PROPERTY ADDRESS / a� (A fl'1 <br /> LEGAL DESCRIPTIONLo�. I 0 1a'4 <br /> ,�A -S�-3gt) n <br /> SINGLE FAMILY DWELLING ❑ ARAGE/ CESSORY STRUCTURE ADDITION ❑ STAIRS ❑ � " o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADDIING Cl CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ <br /> CS4Yage V- CAGB `t)fpPei 2/ � <br /> STRUCTURE/ADDITION USE: _ .. <br /> (Home/&b r • Commerce I Business; Bedroom; D ck; etc.) r o <br /> BUILDING CONTRACTOR: —� ,Y�iA h <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS r- <br /> WILL BE RETURNED. n <br /> O 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) C ° <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. p <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 <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) c <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK a <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. N p <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (DF), AND ALL DISTANCES .°� o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 5' <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE a <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONEWHEN <br /> NEEDED. � <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Z i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 7' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. w <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER " <br /> SETBACK AREA. <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. m� at7 � <br /> F <br /> n n3Fxf; e <br /> I declare that this applicati,correct a (Including any accompanying schedule)has been examined by me and u the best of or knowledge � Z y a <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 7 e 2 <br /> am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all d •+s+`=''^6+^`'+ <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 — 6'. <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- o n <br /> described premises at any reasonable time for the purpose of inspection. 3 .,, y <br /> OWNER'S SIGNATURE ` �' Z� •-OH o m S 'a 'en <br /> Z' <br /> w (date) a' n e <br /> ZONING ADMINISTRATOR I1/fin I ` y ti '^a � <br /> C <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE 8 N o <br />