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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a — z <br /> APPLICATION FOR LAND USE PERMITS �1 <br /> y <br /> G�OWNER 0t7 I`/ r TELEPHONE 7/C 71 tX6 7 <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS x7577 Ault a e � . lil.ebs u� al S5�8q,� <br /> /\\� a C' <br /> LEGAL DESCRIPTION �• 1 <br /> ffffJJJ-F S CJ <br /> TYPE OF PERMIf(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK GARAGE/ACCESSORY STRUCTURE ❑ vi <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> �o cK <br /> STRUCFURE/ADDITION USE: <br /> (Home/Cabin, Commercial Business, Bedroom; Deck; etc.) z <br /> BUILDING CONTRACTOR: o <br /> i <br /> n <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Y:X11 SHEET <br /> WILL BE RETURNED. OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS 0 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> b <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, 3 l� <br /> AND INDICATE NORTH (N). .9 O, <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) ?A) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S) TO THE ORDINARY HIGH WATER MARK S' CD <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. f° 1 <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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE "3 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. = y <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN y W <br /> NEEDED. <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: <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. o Y Q <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. CT <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ON6. LY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 7. <br /> � �' ao no u� aoro <br /> g N 6 t'y <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my <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 aocompanying schedule)and I further declare that I recognize that this ^ V $ <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin In detennlnirg 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 et providing In this <br /> application. I agree to permit menti officialsat <br /> charged ble administrating county ordinances or other authorized person to have ° <br /> access to the above-described premises at any reasonable time for the purpose of inspection. <br /> n ao �3No > <br /> OWNER'S SIGNATURE //1_ a 0 0 0 o y <br /> /Ol 09 <br /> r� a �OdmnO <br /> ',�I (date) <br /> ZONING ADMINISTRATOR_ �/ <br /> TOWNSHIP PERMITS MAY BE REQUIRED E w <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ^ <br /> o S <br />