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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS : r <br /> OWNER / / TELEPHONE <br /> MAILING ADDRESS <br /> PROfTY DDRE / �'� <br /> fro rat c 0 A <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING C ADDITION C DECK;k GARAGE/ACCESSORY STRUCTURE C �f <br /> BUNKHOUSE C 59.692(1V)GAZEBO C STAIRS C FILLING/GRADING C CAMPING UNIT O <br /> COMMERCIAL BUILDING <br /> � C C COMMERCIAL ADDITION COMMERCIAL ACCESSORY STRUCTURE C <br /> �J[7. <br /> STRUCTURE/ADDITION USE: C GCt_.—� 95 <br /> 95 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> n <br /> O 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Va X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS c <br /> WILL BE RETURNED. r <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) r a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. c <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW m r <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). '�,� 7. <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK ,r <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST) AND DRAINFIELD (DF), AND ALL DISTANCES S. <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. 1 fv <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n <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. a <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. <br /> ^ ;tf >nnnc > o -Z <br /> � 3 3 3 n' crt t7 <br /> A E 9 7 <br /> zx � <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my B 0 p R. F. F a r <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all L y R e <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this `'> > ti <br /> Informatlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I `` S i <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this �_ ,R in 'u: w w 7 <br /> application. I agree to perms county officials charged with administrating county ordinances or other authorized person to/hav ,^.^, ' 25$access to the above-descd premises at any reasonable time f e purpose of InspeGion. S >OWNER'S SIGNATURE / v> > <br /> m ` - °-Fa C <br /> , <br /> (date) c = <br /> 20NING ADMINISTRATORTii=largam w : <br /> z <br /> Cil <br /> 23, <br /> TOWNSHIP PERMITS MAY BE REQUIRED a « <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ti o N s <br /> Pe �� lef /tic ��c collee/ �t c as�9 ,..so0000 <br />