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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator y o <br /> APPLICATION FOR LAND USE PERMITS <br /> m y <br /> OWNER I� TELEPHONE C \ c <br /> A;C/, <br /> MAILING ADDRESS /,an incl )01l <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION / �/� / ( - <br /> �e5" 7irj 60 <br /> o S Des <br /> DWELLING/BUILDING)a GAPAGE/ACCESSOKYSTWJMRECI ADDITION ❑ STAIRS ❑ <br /> TYPE OF PERMIT(S): ,o <br /> FILLING/GRADING ❑ CAMPING UNIT❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ n <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) o P <br /> BUILDING CONTRACTOR: In <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Va X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O L: <br /> WILL BE RETURNED. 1— <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 2 <br /> l) w a <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 <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) BUILDING(S) SU <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM) OF LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <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. n o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE f <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. Q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN g cz) <br /> NEEDED. a <br /> o to <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: b <br /> a <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. i <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 /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. t7 <br /> � R�� Ra � l7 <br /> 7. � 2 c 5 . d e w <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge " C P <br /> and belief lt Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information ''^ 7 y' y <br /> o g <br /> contained In this application(including any accompanying schedule)and I further declare that I recognize that this InPormatlon I <br /> am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I further accept all ^ N o W $ <br /> liability that may be a result of the County of Burnett relying on this information I am providing In this application. I agree to <br /> Permit county offldals charged with administrating county ordinances or other authorized person to have access to the above- o f1 <br /> described premises at any reasonable time for the purpose of Inspection. m y c > <br /> SIGN HERE �iwlirfi Ulm �'� Zy-O�p o S 6OZ <br /> (sigq—turere of owner of Ilding contracoor) (date) y, _ a . <br /> ZONING ADMINISTRATOR On i ' <br /> E; <br /> TOWNSHIP PERMTrS MAY BE REQUIRED H <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE w w <br /> Pion 1 - --1- le4--k -it IUDs-hland &blob/S B-a5-ab <br />