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c Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g ° <br /> APPLICATION FOR LAND USE PERMITS y C� <br /> OWNERG�or)M •l Ww,I zo TELEPHONE <br /> c <br /> MAILING ADDRESS 06 0-LqLt4& <br /> G( T LI 9�Sy <br /> PROPERTY ADDRESS /..�J /Yl .J 12d A e <br /> LEGAL DESCRIPTION o O <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADD TION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ o `° <br /> STRUCTURE/ADDITION USE: rll. Q.r GY>1 <br /> (Home/Cabin; ConiFAerclal Bu iness; edroom; Deck; etc.) CZ <br /> BUILDINGBUILDING CONTRACTOR: n L 7- <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yx X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C oC"_ N <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C O <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). ) N Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) <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. p <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (DF), AND ALL DISTANCES 5, ai <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. El �, <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 1 o O <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> W <br /> NEEDED. I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <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. C <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. J <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER y( <br /> SETBACK AREA. I 1J <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 7. > a <br /> � � E' cl � 7 <br /> F ^ y 33 n a = 77 <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 0,°z R S ? w' <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all E m = w F_ P .3 <br /> Information contained in this application(Including any accompanying schedule)and I further declare that I recognize that this E. a a m N <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. 1 a E= b <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing in this c 5 <br /> application. 1 agree to permit county officials charged with administrating countyrdinances or other authorized person to have � r <br /> access to the above-described premises at sonable time for the purpo f Inspection. F w w� f1 <br /> A Eo <br /> y <br /> o <br /> OWNER'S SIGNATURE A O <br /> (date) Ez <br /> TO �hZONING ADMINISTRATOR <br /> h <br /> C : m til <br /> _ x a <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> vi o 000 <br /> rrwy o�-4- re tor2a !Q " Zb /D�l�� <br />