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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 /> W <br /> OWNERA4 I! Amer CML TELEPHONE <br /> J r w <br /> MAILING ADDRESS <br /> /V �Y/O 7�f scc"g, "r PLe� htn< v�if �t4 <br /> PROPERTY ADDRESS q, I/ �p �CCe f)iG V' / � <br /> LEGAL DESCRIPTION T'P O V V t—+ I s <br /> TYPE OF PERMrr(5): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ (T <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE O <br /> STRUCTURE/ADDITION USE: Li_AllR 5 t Z <br /> (H//o--me/Cabin; Commercial Business; Bedroom; Deck; etc.) ° <br /> BUILDING CONTRACTOR: C n 3 <br /> O <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 /> � m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. a 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, EI <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) .0TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK wR. <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. ty <br /> 4. SHOW THE LOCATION OF THE WELL (W), SEPTIC TANK (ST) AND DRAINFIELD (DF),AND ALL DISTANCES 5. y U-) 00 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 1 <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, ETC., THE _ <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 6 <br /> I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN J y Oi <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> i <br /> ro <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. z O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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. rh <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. z a0 0 o <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my c o 2 8 <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all 2". <br /> information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this <br /> amt : <br /> information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I m ?a 'a a= : Y <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this ' ` in in 'b <br /> �5. : <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to n n m <br /> have access to the above-described py reasonable time for the purpose of Inspection.^^ ° D <br /> OWNER'S SIGNATURE g -3 <br /> (date) A .2 <br /> '�Td� n �i9 n�7 - = Z <br /> ZONING ADMINISTRATOR J,Jm F lant#G(n Q o S <br /> ' _C <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ? r <br /> �'-✓/hal- d- I� �}� �IC�P(�( f.�f� ,bc� �i)v)iSC'a2SfYUChov� lD-b-OS' �d,NU�N=' <br /> � Ng000g <br />