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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator z <br /> APPLICATION FOR LAND USE PERMITS N y <br /> OWNERV ,Lh,� TELEPHONE <br /> �Dt1 CkC O <br /> O <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS �7� I I J)U� 10YA <br /> � <br /> Y <br /> C) <br /> i g ti <br /> LEGAL DESCRIPTION �////���I���>�� �✓V'� v I , I�I ?. <br /> --- <br /> SINGLE FAMILY DWELLING ❑ GAKIVGEj ACCESSORY STRUCTURE ❑ ADDITION E01 STAIR Co ro <br /> TYPE of PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ BUNKHOUSE CI59.692(1V)GAZEBO ❑ DECK -¢-- z <br /> — IIJJ <br /> STRUCTURE/ADDITION USE: TI Imo <br /> X10 <br /> (Home/Cabin; Commercial Business; Bedroom, Deck, etc.) i <br /> i <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT P 5 C <br /> WILL BE RETURNED. 'b <_ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> I d <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 j yin ro <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, p� <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDIN�G(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK i <br /> N <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. CES p <br /> � � � o <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTA <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.,t'HE 3. 1 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. J' <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE 4EN Cl¢�� <br /> NEEDED. I 1 <br /> j <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. V I <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 <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE NLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. i <br /> 6. <br /> ^ v lr a: ". <br /> 7. <br /> 1 declare that MIs application(including any accompanying schedule)has been e"mined by me and to the best of my knowl a <br /> and belief It is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of all Information <br /> contained In this application(including any accompanying schedule)and I further declare that I recognize that this InPortnatl n I N 8 -e <br /> em providing will be relied upon by Me County of Burnett Wisconsin In determining whether m Issue a pertntt. I further all n N 8 `�'u .fir <br /> liability that may be a result of the County of Burnett relying on this Information I am providing M this application. I agree S <br /> Permit county officials charged with administrating county or <br /> or other authorized penton to have access to the m ,� Y <br /> described Premises at any reasons le time for the purpose of Inspection. <br /> OWNER'S SIGNATURE ` '° > <br /> (date) to : _c w � <br /> ZONING ADMINISTRA <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> u g��o <br />