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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator n o <br /> APPLICATION FOR LAND USE PERMITS a Uj <br /> OWNER I�� TELEPHONE <br /> n <br /> MAILING ADDRESS <br /> t��q��� <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION � n <br /> v V loT Z L I o uJA15 <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE Cl ADDITION Cl STAIRS o + <br /> TYPE OF PERMIT(S): �^ <br /> FILLING/GRADING ❑ CAMPING UNIT❑ BUNKHOUSE❑ 59.692(1V)GAZEBO ❑ DECK❑ <br /> STRUCTURE/ADDITION USE: <br /> z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) c <br /> BUILDING CONTRACTOR: ")k A- <br /> C> <br /> A PLOT PLAN MUST BE PROVIDED ON AN B Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS n <br /> WILL BE RETURNED. p 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 0 o <br /> � 6 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW o <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) BUILDINGS) (7 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK v <br /> (OHWM)OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. N <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES °� v, o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w' <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. c <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. <br /> -1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN L <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: I}�� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. z' <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. B V <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER ` <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. <br /> yyga7. <br /> ro <br /> R3 <br /> S <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information c <br /> contained in this application(including any accompanying schedule)and I further declare that I recognize that this Information I 8 <br /> am providing will be relled upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I further accept all N N 8.a <br /> liability that may be a result of the County of Bumett ylnq on n rmation I am providing In this application. I agree to 8 C" <br /> above- <br /> permit county officials charged withad Inistrju ty o antes r other authorized person to have access to the above- 6 `" <br /> described premises at any reasonabmgl6r the f InspeStlon. o s= y <br /> V o <br /> 1. <br /> OWNER'S SIGNATURE <br /> z <br /> (date) �^ <br /> V Y I fN 11�cm v, o a <br /> ZONING ADMINISTRATOR <br /> R , <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N 8 o <br />