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z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS h <br /> y <br /> OWNER 1 G I ' , /)h TELEPHONE <br /> rl �J / VQF <br /> MAILING ADDRESSI 1 / / /� / �'-j <br /> 7 L 1 l CSS 1, s �, U c,J ( /y//1/. <br /> PROPERTY ADDRESS /+ / I ^� <br /> C'( o <br /> LEGAL DESCRIPTION c <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECKE] GARAGE/ACCESSORY STRUCTURE <br /> 3 <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 c ^� <br /> STRUCTURE/ADDITION USE: r n c 1 <br /> (Home/Cabin; Comm r al Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: n <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Ma X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS a <br /> WILL BE RETURNED. <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) o <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 tyf awe " o <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, ',35 O <br /> AND INDICATE NORTH (N). N Z J <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S) TO ALL LOT LINES, (B) BUILDING(S) ° O <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK W <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. p <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES a ^, <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I l7 <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. V'1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. — Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r <br /> d J <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Z O p <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. rJ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER C <br /> SETBACK AREA. U W <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. I O <br /> NOT TO BE USED FOR HUMAN HABITATION. G <br /> 6. <br /> 7. yo 0 o ncD. o '0 <br /> I declare that this application (Including any accompanying schedule)has been examined by me and to the best of my a 0,°2 on ^ ? w' <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all <br /> Information contained in this application(Including any accompanying schedule)and I further declare that I recognize that this a > a m N <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this o qZ <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 p7lfes at any reasonable time for the purpose of inspection. ° 'w i5 5 <br /> .. 3 •=1 u yccoo opo a1 <br /> OWNER'S SIGNATURE n n > E d ty h = 2 <br /> (date) <br /> n <br /> ZONING ADMINISTRATOR Son <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N N o U o <br /> 00000 <br />