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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator c o <br /> APPLICATION FOR LAND USE PERMITS a . <br /> z <br /> ° <br /> OWNER /. jJ� TELEPHONE 2.2� <br /> 4' <br /> f" 1 <br /> MAILING ADDRESS <br /> R <br /> PROPERTY ADDRESS CRm E <br /> Cl�/ <br /> LEGAL DESCRIPTION r�01 O 7—jpV W171 L <br /> 4 <br /> 1 7, / /oT1 esM l�i�P�519 6'oy o � <br /> TYPE OF PERMIT(S): <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ElSTAIRS o <br /> v <br /> FILLING/GRADING ❑ CAMPING UNIT 0 BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ <br /> STRUCTURE/ADDITION USE: _L522V Gr,AY Tb �L7i(�F.S/?r0/pE Z <br /> (Home/Cab, ; Commercial Business; Bedroom; Deck; etc.) S ° <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 81/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS n <br /> WILL BE RETURNED. p 3, <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) c <br /> � 6 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. ,4nf O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW y <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, til 'e <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) n <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 4 <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. N <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> w <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 0 c <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE i;. <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. nI <br /> j 9u <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. (� V <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: I I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. P <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. r1 \ <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. <br /> NOT TO BE USED FOR HUMAN HABITATION. Q <br /> 6. <br /> a 'p �(1m C7 a C7 b <br /> 7. <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information <br /> 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 <br /> liability that may be a result of the County of Burnett retying on this Information I am providing In this application. I agree to <br /> pem it county officials charged with administrating county ordinances or other authorized person to have access to the above- S <br /> described premises at any reasonable time for the purpose of inspection. y <br /> OWNER'S SIGNATURE S P' <br /> (date) o^ d .� <br /> ZONING ADMINISTRATOR ( 1 <br /> < : e <br /> TOWNSHIP PERMITS MAY BE REQUIRED Rl1RNETT COUNTY <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANC w w <br /> CONING <br />