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rn v Z <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator a o <br /> APPLICATION FOR LAND USE PERMITS <br /> a <br /> OWNER TELEPHONE Ih tob <br /> MAILING ADDRESS <br /> PROPERTY ADDRESSlake <br /> r <br /> o y <br /> LEGAL DESCRIPTION a <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDIITON ❑ DECK G GE/ACCESSORY STRUCTURE❑ <br /> BUNKHOUSE❑ 59.692(SV)GAZEBO ❑ STAIRS❑ FILLIN /GRADING ❑ CAMPING UNIT❑ r- 2. <br /> 0 <br /> 2 <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ ° <br /> STRUCTURE/ADDITION USE: <br /> e a I o mesa usiness; room; eC ; e . <br /> n � <br /> BUILDING CONTRACTOR: <br /> O � <br /> � o <br /> c <br /> A PLOT PLAN MUST BE PROVIDED ON AN 6th X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLAITS � $ <br /> WILL BE RETURNED. f] O <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. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW C> ( o <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, J <br /> AND INDICATE NORTH(N). p c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) <br /> CD <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 1 <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. W <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES Su ) <br /> TO BUILDINGS,ROADS,LAKE,LOT LINES. o <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Q o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE r l <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 /> r i <br /> NEEDED, r R y <br /> V I rn <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: n 1 <br /> w Z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. () n <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. y <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER p <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. ^C <br /> NOT TO BE USED FOR HUMAN HABITATION. f <br /> 6• � zannnnaoro <br /> �ZF �e )alhirm1` � zy � 3 <br /> �. EE � <br /> �{ al y 9330• o. c � <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the hest of my y <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all w a <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this <br /> Information I am providing will be relied upon b the County = ° `^ ^' 00 <br /> p 9 P Y My o!Burnett Wisconsin in determining whether to Issue a permit. I „ p ^ N o <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 !~ o <br /> : w w <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have m ��, <br /> access to the above-described premises at any reasonable time for the purpose of inspection. 3 m Q S o O y <br /> OWNER'S SIGNATURE 2 <br /> 0 <br /> (date) <br /> o' <br /> 20NING ADMINISTRATOR <br /> y m _ <br /> C • Yf" 00 <br /> TOWNSHIP MITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE 22 ` <br /> fA� pN df bi`A � <br /> tJii U 'J O O O o <br />