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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a 3 Z <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER <br /> TELEPHONE <br /> MAILING ADDRESS s/ V2 I ^ <br /> PROPERTY ADDRESS q Q LULa lee -rr <br /> / W <br /> � o <br /> LEGAL DESCRIPTION ,`.• IZ> <br /> o <br /> TYPE OF PERM17(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT Cl <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITIO./N-�O COMMERCIAL ACCESSORY STRUCTURE 0 e W <br /> STRUCTURE/ADDITION USE: l/ <br /> (Home/Cabin; U>vrnrnerciai Business; BeCh m; Deck; a .) - I b ?t <br /> BUILDING CONTRACTOR: - C <br /> !A <br /> A PLOT PLAN MU57 BE PROVIDED ON AN 8 yz X11 SHEET OF DAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS 0 0 L� <br /> WILL BE RETURNED. ff'' _ <br /> OKCC <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW b •^'- c <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH(N). y`) <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B)BUILDINGS) o o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK w <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 <br /> TO BUILDINGS, ROADS,LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. _ rn <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE c UI <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 <br /> NEEDED. o` y <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: .� 6 <br /> I. 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. n z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 0; X <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER I� O <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. F <br /> 7. <br /> I dedare that this application(including any accompanying schedule)has been examined by me and to the best of my 5 e It: °� <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all q B." , <br /> 'm w <br /> Information contained in this application(including any accompanying schedule)and I further declare that I recognize that this m> >m b,i y <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permlL I ' R $n^ Y <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this c .�.H�.'9 <br /> application. I agree to perm t munty oAici rged with administratlnq county ordinances or other authorized pennon to have `—'^�+ fro' <br /> access to the above-desodbed premises a an nabla time for the purpose of inspection. b Cq 'Z <br /> to <br /> OWNER'S SIGNATURE „ ., <br /> // . (date) g <br /> ORV ZONING ADMINISTRATOR <br /> " = 8 c S Film <br /> TOWNSHIP PERMITS MAY BE REQUIRED Q n <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE - «» <br /> 6. G CG J N N N N U <br /> �- <br /> 13-c� <br />