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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator n <br /> APPLICATION FOR LAND USE PERMITS s <br /> OWNER oA-N, ;-dor l�. L �,v TELEPHONE gys o n <br /> MAILING ADDRESS 9�/ 3 � <br /> � led P',49 <br /> (P / <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION <br /> DWELLING/B ILDING ❑ GARAGE/ACCESSORYSTRUCTURE,5,, ADDITION ❑ STAIRS ❑ <br /> TYPE OF PERMIT(S): i <br /> FILLING/GRADING ❑ CAMPING UNIT O BUNKHOUSE 0 59.692(1V)GAZEBO ❑ DECK ❑ Oj <br /> n <br /> STRUCTURE/ADDITION USE: G z <br /> (Home/Cabin; Co ercial Business; Bedroom; Deck; etc.) o <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED N AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C S J <br /> WILL BE RETURNED. A y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> A w $ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. ht O R <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW I S <br /> BUILDINGS/STRUCTURE (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) c <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM) OF LAKE, STREA OR RIVER AND MEASUREMENT TO WETLAND AREAS. z <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 0 <br /> 6. IF SEPARATE PLANS ARE SUBMMED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE v <br /> PLANS MUST BE SIGNED kND DATED BY THE OWNER. c 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN -� <br /> NEEDED. " <br /> SQt m <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> s' a o <br /> 1. DRIVEWAY MUST MEET D IIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING O TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. } '� <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 3 3 O <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. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. f»u s4 be ?17-15' -(Yom Off K)m q p <br /> R � n3mR $ ^ [�:1 <br /> 7. E. 2• 3 0 <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information ^ o Y <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 relied upon by Me County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all c N g U g <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 ^ .. <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- 8 5 (� <br /> described premises y reasonable me for Me purpose of Inspection. 0 v, w =' Y <br /> 3 8 3 0 0 <br /> SIGN HERE - b7 A U„ to t <br /> If (slgnatu \ ner or building contractor) ate) <br /> ZONING ADMINISTRATOR m l a '( t"t <br /> < o <br /> TWNSHIP rc-;PERMITS MAY BE REQUIRED <br /> N N N U <br /> THIS PERMIT HALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE 8 U o <br />