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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator P <br /> APPLICATION FOR LAND USE PERMITS Gl <br /> OWNER �ro.JI �Q TELEPHONE <br /> MAILING ADDRESS(-('J(/ I�� � I <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION <br /> o <br /> SINGLE FAMILY DWELLING C3GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ STAIRS t7 5 <br /> TYPE OF PE0.MIT(S): <br /> FILLING/GRADING❑ CAMPING UNIT 0 BUNKHOUSE ❑ 59.692(1V)GAZEBO 0 DECKX ,o <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) I c <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yx X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O (vn, <br /> WILL BE RETURNED. Tt < <br /> O ° <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. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW C ° <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, tif 'O K o <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) z <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK I P <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. 5 <br /> 4, SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTANCES p <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. f� <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. to <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. '-i <br /> NOTE: NG/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> NEEDED. _ <br /> '-1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. rrte,,11 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n W <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. E z <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER N <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. ( I� <br /> NOT TO BE USED FOR HUMAN HABITATION. T� <br /> 6. �1 <br /> 7. <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge >n Em U> <br /> and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information "— <br /> contained in this application(including any accompanying schedule)and I further declare that I recognize that this Information I <br /> am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all o <br /> liability that may be a result of the County of Burnett relying on this Information I am providing In this application. I agree to E. <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- <br /> described premises at any reasonable time Por=psespectlon. <br /> ���� <br /> OWNER'S SIGNATURE:7 <br /> ` (date) d n :' ' 5' H <br /> ZONING ADMINISTRATOR ria ��/l c H . 14 <br /> TOWNSHIP PERMITS MAY BE REQUIRED Uli <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> P irkedp b Fred �66- g <br /> y 9 <br />