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b z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER BVI h �Oi / L L�� 16 S k l- 7� <br /> TELEPHONE '- _ 6 <br /> u0 <br /> MAILINGADDRESS <br /> CsrmVe, r 1/� <br /> PROPERTY ADDRESS \ w <br /> c � Z <br /> LEGAL DESCRIPTION o <br /> rrrE of PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITIONX DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ 4- <br /> BUNKHOUSE <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING El COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ S �� <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) 0C"� 3 <br /> - R <br /> BUILDING CONTRACTOR: <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 81/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS � o <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) '��t� <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C <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, QQ a53 <br /> AND INDICATE NORTH (N). o \ z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) v P <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. <br /> 4. SHOW THE LOCATION OF THE WELL (W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES N V <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Q� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE {Jj o <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. �� O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n f% <br /> 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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER I N -� <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 /> 7. > r) > <br /> X33EN <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my 3 F 0�$ <br /> 9 3 3 <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 accompanying schedule)and I further declare that I recognize that this ��. > > W `� <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I as <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have '° L) o o o 0 <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. wN u <br /> R w o o <br /> 3 Wy > 0 0 0 0 0 <br /> OWNER'S SIGNATURE <br /> psis > �. m � r'j <br /> ZONING ADMINISTRATOR M <br /> o . <br /> fn f° 5 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE `5 <br /> ✓IGir) ✓hQiS ✓ �'C � � � � � <br />