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� Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS <br /> o <br /> OWNERV Q hV-) TELEPHONE - 'v <br /> MAILINGADDRESS 5-I� 'p1Qia-{{� �/ �L5{J�• 0 �. <br /> PROPERTY ADDRESS <br /> D <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMTT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK O GARAGE/ACCESSORY STRUCTURE ❑ r .� <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ R (� <br /> STRUCTURE/ADDITION USE: - I v 1G(nIA M <4j (+J <br /> (Home/Ca— '6' ; ClommeerciaBusiness;//Bedroom; <br /> /Deck; etc.) , O <br /> BUILDING CONTRACTOR: F7re&SL <br /> 0 , g <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 rh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) v l/ .gni C �y <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 tin r <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, p <br /> AND INDICATE NORTH (N). U1 SSU Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING-MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 69 <br /> (OHWM)OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. = �,Cn <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 /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. y <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE ',, �d U� 9 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 r C4 W <br /> NEEDED. <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW:' <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. Z �d <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 7. > c" > s m <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my a'71 <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all E. <br /> Information contalned In this application(Including any accompanying schedule)and I further declare that I recognize that this =_. > > m ,, <br /> o: R o-Burnett Information I am providing will be relied upon by the County of Buett Wisconsin In determining whether to Issue a permit. [ .� aE:— <br /> further accept all liability that may be a result of the County of Burnett relying on this Inforrnatlon I am providing In this <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have <br /> o : <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. ' ' ;,�w N n <br /> OWNER'S SIGNATURE �® (date) <br /> ZONING ADMINISTRAT n n <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE :w <br /> LAP <br />