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L Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> _ APPLICATION FOR LAND USE PERMITS N <br /> OWNERj uky y l ' TELEPHONE L,&t—Z�o- <br /> MAILING ADDRESS ft 1 (VLOI _ I�1�'^�/ a0 �C�I JM/N (//�2_ <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMrr(5): SINGLE--FAMILY DWELLING ❑ ADDITION ❑ DECK X GARAGE/ACCESSORY STRUCTURE _ } <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ r�"\ <br /> COMMERCIAL BUILDING ❑1_ COMMERCIAL ADDITION ❑ CpOMM RCIIAJL ACCESSORY STRUCTURE ❑ o <br /> STRUCTURE/ADDITION USE: M�1 `�L ifn`Ct 'I`�vim' <br /> Z S <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) 11> <br /> BUILDING CONTRACTOR: t)J <br /> 3 � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 81/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o_ <br /> WILL BE RETURNED. e <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) O S <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW t� w <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, ^F c <br /> AND INDICATE NORTH (N). N Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) W ° <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. t7 <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF),AND ALL DISTANCES 3. <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE o <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 /> NEEDED. <br /> R) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r G <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. S <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. I� <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. <br /> 7. a >o ro <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 0,°2F, w' <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all "o.�w P_ d oma. H <br /> Information contained In this application(including any accompanying schedule)and I further declare that I recognize that this v �: D 9 m ,'4 <br /> information I am providing will be relled upon by the County of Bumett Wisconsin In determining whether to Issue a permit. I a ? Z .p <br /> further accept all liability that may be a result of the County of Burned relying on this information I am providing in this <br /> application. I agree to permit county officials c arged with administrating county ordinances or other authorized person to have <br /> access to the above-described premises at an asonable time for the purpose of inspection. <br /> a <br /> '> o 0 0 0 o y <br /> OWNER'S SIGNATURE <br /> (date) onc$ x,El <br /> ZONING ADMINISTRAT 7 1 ` h �? � F ri m <br /> _ A <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N " <br /> �e(rni � d 6t6� U � 00000 <br />