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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator G Z <br /> APPLICATION FOR LAND USE PERMITS <br /> N <br /> OWNER � C (}�ICr u� TELEPHONE �,, ) ... ,� r�/'`1 a �) <br /> MAILING ADDRESS i13 <br /> W , <br /> PROPERTY ADDRESS 7 j <br /> (l n. <br /> LEGAL DESCRIPTION <br /> TYVE OF VERMIT(5): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSDRY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDIN ❑ COMMERCIAL ADDITION ❑ S[�.7MERCIAL ACCESSORY STRUCTURE ❑ r <br /> c 3 <br /> STRUCTURE/ADDITION USE: 1'��E t�A U-, <br /> (Home/Cabin, Commercial Business; Bedroom; Deck; etc.) - \ <br /> ,BUILDING CONTRACTOR: <br /> \ y b <br /> A PLOT PLAN MUST BE PROVIDED ON AN 6 Vx <br /> WILL BE RETURNED. X11 SHEET OF PAPER, ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> o` <br /> DIRECTIONS FOR PLOT PIAN DRAWING: (ARIAL OR TOP VIEW) r) a <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, <br /> AND INDICATE NORTH (N). \ a <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) P <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 5(OHW ' <br /> 4. SHOW nT)EFLAKE,STREAM OR RIVER AND WETLAND LOCATION OF THE WELL(W),SEPTIC TANK (SAND DRAINFIELD (DF),AND ALL DISTANCES O. <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. w <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE "'I d <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. y O C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: f� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. v O� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. F (� <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 /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. � <br /> 7. 1- <br /> > p > 0 <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my <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 <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I ,� d n $ <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this ' •^ 7 H H W <br /> application. I agree to permit county om Is cha d with administrating county ordinances or other authorizederson to have <br /> access to the above-desvibed premises ny re nable time for the purpose of inspection. p o <br /> c qy 5 S$ o oS8 y <br /> OWNER'S SIGNATURE - t — C z n ME ., <br /> a =:mnpy„ O <br /> I tiV ! �vy/V x (date) n'e 3 I 6 - 2' <br /> ZONING ADMINISTRATOR <br /> v e w S C <br /> m'u M <br /> mo or y <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N <br /> Pe/rr►I-t,i- Piceon Ile 1-'V &b F�eir� 3-a V,N $0 0 0$ <br />