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Burnett County 7410 County Road K,No.102, Siren,WI 54872 Offioa of Zoning Administrator e o <br /> APPLICATION FOR LAND USE PERMITS <br /> a <br /> OWNER ,.' 1 aLL 'l F't Y-r- TELEPHONE <br /> MAILING ADDRESS <br /> L �f <br /> PROPERTY ADDRESS <br /> ES/� <br /> LEGAL DESCRIPTION S <br /> TYPE OP pBWLT(S): SINGLE•FAMILY DWELLING❑ ADDITION❑ DECK❑ GARAGE/AOCFSSORY STRUCTURE M <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO ClSTAIRS❑ FILLING/GRADING❑ CAMPING UNIT❑ F1 <br /> OOMMERCTAL BUILDING 0 COMMERCIAL ADDITION❑ COMMERCIAL ACCESSORY STRUCTURE O E <br /> STRUCTURE/ADDITION USE: if A ECK <br /> o <br /> (Home/Cabin;CanmPerdal Buss ;Bedroom;Deck etc.) <br /> BUILDING CONTRACTOR: L•. ( k P � m n<-v <br /> o � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 W X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS 0 <br /> WILL BE RETURNED. <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. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL DISTING SUILDINGWSTRUCTURES(W AND ALL NEW w 3 <br /> BUILDIN(S/STRUCTURES(Na),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, 1Pz <br /> AND INDICATE NORTH(N). <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 MEASUREMENTS)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETUWD MEAS,AND(D)LOT DIMENSIONS. D <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES 5 w <br /> TO BUILDINGS,ROADS,LAKE,LOT LINES. LLEDSJ <br /> S. INDICATE IF A WALKOUT BASE 14E NT IS PLANNED AND SHOW MEAS TO BE GRADED OR FI . y <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE C� o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. Oci <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN -1 l <br /> NEEDED. <br /> THIS PERMIT IS SUB7ECr TO ALL CONDITIONS LISTED BELOW: IT C Cq (J� <br /> 1. DRIVEWAY MUST MEET oitmwY WIDTH REQuIREmENTS WITHIN 60 DAYS OF PERMIT. z (Qy <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION 15 RESTRICTED ALONG SHORELINE <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK MEA. ONLY. <br /> 5. ACCESSORY 5nWCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORACE+ <br /> NOT TO BE USED PORHUMAN HABITATION. <br /> 6. /+S S , k / blU, <br /> 7. <br /> i <br /> I declare that this aPPilication(Including any acromPanying KhWulean w <br /> )has bow by ma and to the beet of my braadedpe <br /> and belief it is crus,correct and complete. I acleawledge that I am responsible for the detall and acuaacr of all InMmation m D m <br /> contained in this application(Including any accompanying schedule)and I further declare that I nragnize tact this Information I <br /> of Burnett Wiaamsdn In determining whetherto issue a Permit I fmthar ac"Pt all <br /> am Providing willay a retied upon by tM Cy of S in this application. I agraa m i <br /> permit that may c a mWtod ofthe q on this ss or other <br /> en I am providing „ <br /> permit aunty oniclale clnaf9ad mmW ordinances ass otlror authorised parses to have atasss to the above- 8 � � <br /> descibed ba prnmat any ressoname time for the purpose of Inspection. �+ w 8 8 8 <br /> OWNER'S SIGNATURE <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED O«L,N <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE S a / N $0 0 c $ <br /> Own �,t i e.f-4e.r peed L�t f bLj <br />