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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator z <br /> APPLICATION FOR LAND USE PERMITS a . <br /> N <br /> O h <br /> OWNERC <br /> TELEPHONE <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS `L <br /> u <br /> a p'r/4' <br /> ' 0 o y µC C�+ � Ht ,V ' 3G2S <br /> LE DCr_ESCRIPTION ,(�� q,u LC�n l y �1� o � <br /> SINGE FAMIL DWEL NG ❑ G RAGE/AC 5 RY U TUR DDITION 0 STAIRS o �' <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING 0 CAMPIN UNIT ❑ BUNKHOUSE 0 59.692(1V)GAZEBO ❑ DECK 0 I� <br /> STRUCTURE/ADDITION USE: /uc,-&u <br /> M1(Home/ abin; Commercial Business; Bedroom; Deck; etc.) o ° <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 %X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. O '� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 2' c <br /> � 6 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. I* a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW ,� A <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) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) c <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S) TO THE ORDINARY HIGH WATER MARK E <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. [. y <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 /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. t7 c <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE a <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> H <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN 7O <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> r z <br /> 1. DRIVEVJAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n Jam, <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 U <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. 1 larld;0 Rllowedbe nD3rcc+e,1 cLn 140sgitre �ec� � � a�� vaoro <br /> HUFF :: <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge 3 C A <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information p N o y <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information I 'ad <br /> am providing will be relled 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 Bu tt relying on rnatlon[am provl0ing In this application. I agree to A <br /> permit county officials charged with adminlstre g coun nan s or other authorized person to have access to the above- S w P1 <br /> described premises at rE <br /> b�tlme e se of I ec[lon. m T o y <br /> 3 :`° g G o y <br /> OWNER'S SIGNATU / ,' �'�� c 2So c Z <br /> `f (date) S n Ky <br /> ZONING ADMINISTRATOR ~\' o M <br /> TOWNSHIP PERMITS MAY BE REQUIRED v <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N o <br />