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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER— TELEPHONE /1L�„5 <br /> 'C 'FVI <br /> MAILING ADDRESS _$0 St`n SszI J = <br /> - I (r V(/1IU JJ U J ru <br /> PROPERTY ADDRESS 1 <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ v d <br /> COMMERCIAL BUILDING 13 COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: l a'✓(n 3 <br /> ((Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: Jl �� li S� <br /> c J <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Ya X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANSO o x <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) o _' <br /> R <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 R ^r <br /> BUILDINGS/STRUCTURES (NS), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 07 .� <br /> AND INDICATE NORTH (N). J <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(5) TO ALL LOT LINES, (B) BUILDINGS) <br /> O ? c <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK E' <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. <br /> 4. SHOW THE LOCATION OF THE WELL (W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES p l <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ^hh <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE 4 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. l�) <br /> Ui <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN 91 f 11 <br /> NEEDED. W <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> ry <br /> 1, DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ��' r. p G1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Uj E L 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 OO` <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. f�I <br /> 6, iS <br /> 7. s A D o 0 o C G 0 7 <br /> v 3 3 3 <br /> rBu c ` m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my3 p � � „° <br /> knowledge and belief It Is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of all _P d <br /> P. <br /> Information contained in this application(including any accompanying schedule)and I further declare that I recognize that this __ > o <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 <br /> further accept all liability that may be a result of the County of Burnett relying on this information 1 am providing in this <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have <br /> access to the above-described remises at any reasonable time for thWurpose of inspection. o c o <br /> w N <br /> OWNER'S SIGNATURE �' c <br /> 4p m � o � _ O <br /> � (date) <br /> ZONING ADMINISTRATOR o Ei c�° <br /> I <br /> TOW HIP PERMITS AY BE REQUIRED <br /> THIS PERMIT SHAL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />