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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a o <br /> APPLICATION FOR LAND USE PERMITS <br /> e c <br /> TELEPHONE_ I/ Ij <br /> OWNER �SI - UL Y- L�� 9S m <br /> R �� _ <br /> MAILING ADDRESS_ i <br /> PROPERTY ADDRESS <br /> _ <br /> o <br /> LELoD� 7PONi, /4 �¢ IJ / Sf LhN( <br /> /lf' <br /> SINGLE FAMILY WELLING GEACCESSORY STRUCTURE O ADDITION O STAIRS O <br /> 5 V) _ <br /> TYPE OF PERMn'(5): L _ <br /> FING GRADNGO CAMPINGUNITO BNKHOSEO 59.92(1GAZBOO " <br /> a <br /> DECK ❑y <br /> STRUCTURE/ADDITION USE: t ' 11J S' z <br /> 0 <br /> f <br /> (Home/Cabin; Commercial B siness; Bedroom; Deck; etc.) 1 <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vi X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O <br /> WILL BE RETURNED. c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) o, <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, Pt w <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK I y <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. c rn O Z <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (DF), AND ALL DISTANCES y. P <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 00 `' <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. C1 o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE 4. i <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. y <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: G <br /> z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. e <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. r? L <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 /> 6. nvw U a0 V <br /> aS. <br /> 7. <br /> 'b o w <br /> �2 r <br /> I declare that this application(Indudinq any accompanying schedule)has been examined by me and to the best of my knowledge <br /> and belief It Is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of all Information 9 o g <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 relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all `c_ ^N c U u <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- > <br /> described premises at any reasonable time for the purpose of Inspection. `° G o <br /> A - .. <br /> 1-a8 <br /> OWNER'S SIGNATURE <br /> 1 �' (dam) E� P o^ d ' <br /> �, I 1 Z .a m E w ts1 <br /> ZONING ADMINISTRATOR m�aA"4 <br /> A <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> v• tWiO V � O <br />