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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administratorg ° <br /> APPLICATION FOR LAND USE PERMITS : y <br /> OWNER / TELEPHONE 7/�; _�Z O <br /> _C7' <br /> 79 <br /> MAILING ADDRESS <br /> ell <br /> S 7L <br /> (/ <br /> I <br /> PROPERTY ADDRESS rn c <br /> r <br /> LEGAL DESCRIPTION <br /> VU 1V O m <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCE SORY STRUCTURE ❑ ADDITION ❑ STAIRS I I g <br /> TYPE OF PERMIT(S): �+ <br /> FILLING/GRADING O CAMPING UNIT)J❑/BUNKHOUSE /❑/ 59.692(1V)GAZEBO ❑ DECK ❑ Deb <br /> STRUCTURE/ADDITION USE: (OI�I�C�r�/�! dJi/G/�hy S �. <br /> (Home/Cabins; Commercial Business; Bedroom; Deck; etc.) I^ c <br /> BUILDING CONTRACTOR: J <br /> n <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLAN O <br /> WILL BE RETURNED. C o_ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW r' w <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, t"•f 'O <br /> AND INDICATE NORTH (N). 3 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING( N Z <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM)OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. w' <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCE p <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 su <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN ) <br /> NEEDED. C I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: I( , <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. 3 n <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. z <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. I� <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY <br /> NOT TO BE USED FOR HUMAN HABITATION. Ly <br /> 6. <br /> 7. <br /> q <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge >MMt�aoro <br /> m � n <br /> and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information 2 ^ff v,2 0 <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information I Z c A O a <br /> am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all '2 C R <br /> liability that may be a result of the County of Burnett relying on this Information I am providing In this application. I agree to a?: <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- r`+ <br /> described premises at any reasonabl Ime r the purpose of Inspection. > Ei N`_'�+i,o by <br /> s <br /> OWNER'S SIGNATUREt a ' <br /> Imo, (date) <br /> ZONING ADMINISTRATOR I m r GI o (v� 9' °'a z <br /> w �J <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ° P <br /> v W ONNVHi <br />