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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrato g <br /> APPLICATION FOR LAND USE PERMITS h: N <br /> 6 <br /> OWNERTELEPHONE G <br /> t bra <br /> MAILING ADDRESS '7 5 a 3 0--yon & h clt✓t.. ,"SJ O <br /> I <br /> PROPERTY ADDRESS / I I QQ SS k�. ✓J L C) <br /> LEGAL DESCRIPTION S <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO 0 STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ O <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL CCESSORY STRUCTURE ❑ S' <br /> STRUCTURE/ADDITION USE: _ _ _ O U yr e d G, a <br /> (Home/Cabin; Commercia usiness; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: y <br /> O � � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 rk X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLAP IS o <br /> WILL BE RETURNED. c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) a <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 of w 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, �- p <br /> AND INDICATE NORTH (N). c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(3) G <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S) TO THE ORDINARY HIGH WATER MARK G <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. t7 <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL CIS JANUt S n` <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.,TH c (f <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. Qp <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHE y /`- Cho <br /> NEEDED. ll1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: (y� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Z l/f <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. iv <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. x/11 <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONL . <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. $ M - 0 0 o O n £ <br /> n , 2333 � <br /> ZBAAA �'o"" � ' <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my 3 0 ,� �,g, g � ? w �� <br /> knowled a and belief It is true,correct and complete. 1 acknowledge that 1 am responsible for the detail and accuracy of all 'O <br /> q P P �. to P. pp'. @. a <br /> information contained In this application (Including any accompanying schedule)and I further declare that 1 recognize that this o '��. D D E N <br /> Information 1 am providing will be Iled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I �d ?�= i <br /> further accept all Ilabllity that m y a resuIt of the County of Burnett relying on this Information I am providing in thisv," <br /> application. I agree to permR un officials charged with administrating county ordinances or other authorized person to have '° G) o $ $ <br /> access to the above-described rem ses at any maw time r e pu se of inspection. to J g 64 w N <br /> �f (/ 3 p � 'y $ go$ $ <br /> OWNER'S SIGNAT2RE a" / T O � �' a a(date) °ZONING ADMINISR ���I 1 ' I Q.n( q V ) n <br /> TOWNSHIP PERMITS MAY BE REQUIRED a °° <br /> THPPERMIT SHALL EXPIRE ONE,YEAR FRDM DATE OF ISSUANCE ^N <br /> �rrn( � � IPI r p� ckedtipbt �ebr� Nell �i � $ 000 $ <br />