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o z <br /> 6 <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> w <br /> APPLICATION FOR LAND USE PERMITS a <br /> OWNEr�jTELEPHONE — <br /> U'De-Dirt p 7/S 66 z/ 76q — <br /> MAILING ADDRESS p <br /> SP VLLL �J <br /> l <br /> PROPERTY ADDRESS 2 <br /> LEGAL DESCRIPTION / .t.. CSM Jo(. <br /> LV n <br /> d <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTUREAr <br /> m <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING❑ CAMPING UNIT❑ ? <br /> 0 <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ S <br /> r / f o \v <br /> STRUCTURE/ADDITION USE: S-b�� 2 sA I �-X <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: S'(S <br /> O 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS U H <br /> WILL BE RETURNED. <br /> _ <br /> n � a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) � <br /> o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW O <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, J N a <br /> AND INDICATE NORTH (N). 6 O C) <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) R. P <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK l <br /> (OHWM)OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. Al <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. ^ , <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. c <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN (� <br /> NEEDED. I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: F <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. T A <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. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. EO l7 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 F 4i .' <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all y = w m c' <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this `. S am N <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I °i c ?w'`- <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this <br /> have amen access tolication. I atghe abovto eermit county desc"r premises at anyed with reasonable time the county <br /> ordinances or f nspectionther authorized person to o d D : Oo . 5R . <br /> P Y purpose P �A 00o Nw a <br /> OWNER'S SIGNATURE ?�` B A gs o 0 o S O y <br /> (date) <br /> ZONING ADMINISTRATOR <br /> = w : <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> Q <br /> Q = O ss^ w <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE o <br /> 22 <br /> to to p O O O O <br />