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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> e G <br /> OWNER J u y - / / TELEPHONE S� <br /> MAILING ADDRESS <br /> 1 r��lv1;� l Y411, All lJ71c c ') A// <br /> O <br /> PROPERTY ADDRESS ° <br /> LEGAL DESCRIPTIONS r'c /O <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING O ADDITION O DECK❑ GARAGE/ACCESSORY STRUCTURE)W 1 <br /> r. <br /> BUNKHOUSE 0 59.692(1V)GA2EBO O STAIRS❑ FILLING/GRADING❑ CAMPING UNIT❑ 3. C <br /> Z <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMM��E//RCI`ALL ACCESSORY STRUCTURE❑ <br /> STRUCTURE/ADDITION USE: C>k_7 <br /> ome a in; omV raa usiness; room; DECK;etc.) <br /> n U� <br /> BUILDING CONTRACTOR: jo e 71 � A, <br /> O < <br /> F 2 y <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 rh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS � d <br /> WILL BE RETURNED. n O <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. M N n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW p <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH(N). 10 0 ) o <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. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES +c� <br /> TO BUILDINGS,ROADS, LAKE,LOT LINES. c <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. 0) <br /> I c I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN d <br /> NEEDED. �' r <br /> V <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: n , <br /> \ z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. �i f <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. }t <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. YY5 <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. > n n n L) > oti <br /> 7. <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my c Ei <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all '� 6 Y <br /> Information contained In this application(including any accompanying schedule)and I further declare that I recognize that this '6 5 <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 6 C1 5. : <br /> further accept all(lability that maybe a result of the County of Burnett relying on this information I am providing in this 5 > <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have m y ^Y' coo y <br /> m o o <br /> access to the above-described pr miles at any reasonable time(Qr the purpose of inspection. <br /> / — <br /> OWNER'S SIGNATURE C� T — n Ga , <br /> A 'c <br /> n T <br /> ZONING ADMINISTRATO – <br /> R <br /> QQ <br /> OWNSHIP PERMITS MAY BE REQUIRED MAY 8 2012 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF IS CE <br /> BURNETT COU <br /> s� = = o <br /> ZONING <br />