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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator c <br /> APPLICATION FOR LAND USE PERMITS € CN <br /> w ]�✓ <br /> A <br /> OWNER TELEPHONE <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS 19, <br /> I <br /> d( LEGAL DESCRIPTION 0 <br /> SINGLE FAMILY DWELLING ARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ ITAIRS ❑ q <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING❑ CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO O PECK O <br /> STRUCTURE/ADDITION USE: #07x7 C- Z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) !I o <br /> BUILDING CONTRACTOR: C_S7- <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Ya X11 S FET OF PAPER. ANY INcomPFLETE OR ILLEGIBLE PLOT PLANS _ <br /> WILL BE RETURNED. F 3: <br /> _< <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) ! C �) 6 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Irn I O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW!I <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, : .. <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUIDING(S) n <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MF�RK 1 3 <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. It. b <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD(OF), AND ALL DISTANCES In o <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, E#C.,THE c <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. ) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DON WHEN <br /> NEEDED. I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. a Jam, <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGF/STORA¢E ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. F <br /> 6. <br /> 7. w :ew er-- _X <br /> 3 2 Z w r p n 7 <br /> I declare that this applicabod(including any accompanying schedule)has been examined by me and to the best of my len -ledge <br /> and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information F - <br /> contained in this application(including any accompanying schedule)and I further declare that I recognize that this information I T' € I 7 <br /> am providing wilt Oe relied upon Dy a County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all E v <br /> liability that may be a result of unty of Burnett relying on this Information I am providing In Nis application. I agre to c <br /> permit county officials charged Ith dminlstrating cou ordinances or other authorized person to have access m a above- a R f <br /> described premises at any re na le time for the pu se of spectio ¢ YYn W.u� <br /> J Y <br /> OWNER'S SIGNATURE a w •� t i t <br /> < > E <br /> tri <br /> ZONING ADMINISTRATOR v � C u M <br /> E <br /> TOWNSHIP PERMITS MAY BE REQUIRED E «N <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE _ € M <br />