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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administr forn z <br /> APPLICATION FOR LAND USE PERMITS a ° <br /> OWNER <br /> TELEPHONE <br /> v < 70 o <br /> MAILING ADDRESS -10�/I/ <br /> 2ao4"6 �l Y e�✓lPr�s�ee,�v_ ro " <br /> PROPERTY ADDRESS <br /> ,1 ,ISS,©/ fb f�'/STO.P 5�37� SEG /V �f� (� <br /> L GAL DESCRIPTION 7TO <br /> �1✓�.� O/f� Svfj, x.07--�y' D/�,�!!i✓�J TotvN� o' � <' y <br /> SINGLE FAMILY DWELLING 0 GARAGE/ACCESSORY STRUCTURE ❑ ADDITION STAT S ❑ to o ` <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING 0 CCAAMPPING UNIT 0 BUNKHOUSE 0 59.692(1V)GAZEBO 0 DECK <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOTP NS <br /> WILL BE RETURNED. C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) b 0 2 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C7 <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, m v <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 I °3 <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. n, a <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES y o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 5' <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. d o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE 0 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER, - p <br /> H � <br /> NOTE: NEEDEDG/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WH N <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: v l <br /> UI <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <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 Q <br /> SETBACK AREA. Q <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. gN . <br /> 2 <br /> 7y af]m �ba O '9 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledg Z y <br /> and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information <br /> contained In this appllcatlon(Including any accompanying schedule)and I further declare that I recognize that this Information I Y <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept II ` �� «n=' «�N'd <br /> Ilablllty that may be a result of the County of Burnett relying on this Information I am providing In this application. I agree to Ci o U g rro" <br /> permit county ofFlcials charged with administrating county ordinances or other authorized person to have access to the above- S _°' n <br /> described premises at any reasonable time for the purpose of inspe on. m <br /> OWNER'S SIGNATURE_ <br /> � y <br /> (date) � � � g n = � <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE C N o o <br />