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z <br /> o <br /> Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS O <br /> OWNERLO�YJ!> l �'� I <br /> MAILING ADDRESS 1 GGCC-- TELEPHONE t7 <br /> �J � <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION S �G <br /> w J <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE 2. <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE 11 S' B <br /> STRUCTURE/ADDITION USE: f tlbto JG <br /> e a m; Ommercia usmes ; room; ec ; <br /> e c. *4, <br /> J <br /> BUILDING CONTRACTOR: H <br /> 0oq <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O :% <br /> WILL BE RETURNED. <br /> n a <br /> m o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) C m <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 00 0 <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTIJRES, <br /> AND INDICATE NORTH(N). J o rn z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) j l ° <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK Op <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. O CP O <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES ❑. <br /> TO BUILDINGS,ROADS,LAKE, LOT LINES. ti <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 0 41- <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE 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 <br /> NEEDED. (1J <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: Q �, <br /> GI <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. d z d <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O <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 /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. O <br /> NOT TO BE USED FOR HUMAN HABITATION. O' <br /> 6. (� <br /> 7. 'D c o o N > <br /> Ej 3 N 0 'C <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my o,°�� B '� U ? 5 <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all <br /> Information contained in this application(including any accompanying schedule)and I further declare that I recognize that this `° ?. a > tc „, <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I n E: ii E:= > <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person toLl c 8 <br /> have access to the ab <br /> ove-descH remises at any r a m f the Durpose ofinspection. o n D `? .'^„ (y <br /> y <br /> OWNER'S SIGNATURE <br /> (date) n 6n >'2 <br /> Jim <br /> / 0 <br /> ZONING ADMINISTRATOR Cl`; <br /> TOWNSHIP PERMITS MAY BE REQUIRED �E,TH <br /> IS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE . <br /> �4IPS pCf-Pd I to 6y&ugS,aman Eldrs gcoo <br />