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� Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a Z <br /> APPLICATION FOR LAND USE PERMITS �m <br /> OWNER TELEPHONE e J <br /> ��IC Df rcL w2G�VQi� <br /> (A <br /> MAILING <br /> o <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS <br /> t2 I C <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITIONDECK ElGARAGE/ACCESSORY STRUCTURE 11 <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ (� <br /> COMMERCIAL BUILDING'❑�1 COMMERCIAAL <br /> iADDITION 0 COMMERCCIALL ACCESSORY STRUCTURE <br /> 0 <br /> STRUCTURE/ADDITION USE: �/& �/ LA k 0 JVe& SS ' N n-P <br /> (Home/Cabin; mrercial o_ <br /> o � <br /> Busin ss; Bedroo eck; etc.) <br /> Rim <br /> BUILDING CONTRACTOR: n P <br /> 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 6 Y:X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. y <br /> n 6 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE, <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW 9 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, D ! <br /> AND INDICATE NORTH (N). N J o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S) TO ALL LOT LINES, (B) BUILDING(S) CJ' 0 � ` <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S) TO THE ORDINARY HIGH WATER MARK S1 S N <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 q <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 P <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> � r <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN (� <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: m <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. r? r <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. bbb <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. 'h <br /> NOT TO BE USED FOR HUMAN HABITATION. p <br /> 6. O <br /> 7. A DnnnO ap q <br /> F Z o 3 3 3 <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief It is true,correct and complete. I acknowledge MB g gat I am responsible for the detail and accuracy of all a w L L 2 .� <br /> Information contained in this application(including any accompanying schedule)and I further declare that I recognize that this n 5 a a x N <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a pernit. 1 d g $w"' > <br /> further accept all liability that may be a result of the County of Burnett relying on this Information 1 am providing in this g w v+` '_^N "rod <br /> application. I agree to permit cou ty of vials charged with administrating county ordinances or other authorized person to have <br /> access to the above-described ises at any reasonable time for the purpose of Inspection. ° <br /> waowwowa <br /> 3 � d > � o � � g ^7 <br /> OWNER'S SIGNATURE <br /> zs a <br /> (date) <br /> ZONING ADMINISTRATOR I I y O? °c a y S n <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE " <br />