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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator e n o <br /> APPLICATION FOR LAND USE PERMITS g . <br /> y�. p 0 n IOWNER c�� Q� ni�Li mmOnO TELEPHONE � d <br /> n <br /> MAILING ADDRESS �7 �y�� � ^ <br /> PROPERTY ADDRESS � �� <br /> a <br /> LEGAL DESCRIPTION <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ STAIRS ❑ Sl <br /> TYPE OF PERMIT(S): ,0 4 <br /> FILLING/GRADIN ❑ CAMPING UNIT❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ ^ <br /> STRUCTURE/ADDITION USE: �I� > l2� x_3(/7 o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) o <br /> BUILDING CONTRACTOR: M6'• 4 ICA�� A r j lOi n9 S '4— Il C •- <br /> s - <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'k X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS +r <br /> WILL BE RETURNED. A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <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 (ES) AND ALL NEW 4 R <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, R <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 O v <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 <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 m <br /> NEEDED. 'n W <br /> pp c n ' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> m;. <br /> s a <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n w <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ? 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 <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. C> <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> S p 6 <br /> 7. 8 R m ^vm <br /> w <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledgex y 9 � <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detall and accuracy of all Information e <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information I ^ '• Y <br /> N <br /> am providing will be relied 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 relying on this information I am providing In this application. I agree to n u 8 `^ '^ 8 P <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- o Q <br /> described prem s a[any reasonab time for the purpose of Inspection. m``TT� c)�, W 21 y <br /> �. ao C)SIGN HERE �I Z D� n •i C) Z <br /> ( pnature of 6w-neivorbuildinq contractor) (date) H a 8 s Ky <br /> ZONING AD INIS MTOR \�(�� <br /> ^ o <br /> TOWNSHIP PERMITS MAY BE REQUIRED G « [ <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE CU 8 U U o <br /> -PP-vrnC4- + +:P-C r tkP t-fd-In vl,Md r7-a 06 <br />