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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS <br /> N y <br /> OWNER ` TELEPHONE <br /> rc c <br /> M AI V �V <br /> f� L <br /> a <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS nn <br /> 0 <br /> LEGAL DESCRIPTION 1 (5 / to o/ 1/ C <br /> tes <br /> TYPE OF PERMIT(S). SINGLE-FAMILY DWELLING I b ADDITION ❑ D CK ❑ GARAGE/ACCESSORY STRUCTURE 0 m <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 a <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 <br /> STRUCTURE/ADDITION USE: z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) I P <br /> BUILDING CONTRACTOR: IZN F E S OR-77'71 -d'4/P'/� f2JUl�s�j/yJt2/ <br /> &02 V L-)6; f/Ye- S <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vu X11 SHEET OF PAPER. ANY INCOMPLETE OR LLEGIBLE PLOT PLANS A o <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) n o. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. y _� <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, B <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)_TO THE ORDINARY HIGH WATER MARK o` Q <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. O J <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. _ <br /> - 5. -INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. y 4J <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE 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. -q_ <br /> ori o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n C1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. H z O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O <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. O <br /> 6. <br /> 7. Do 0 o Oat? 'v <br /> P06EF. <br /> ."a <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 c o An R- f <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all g � m n. 21 P <br /> Information contained in this application(Including any accompanying schedule)and I further declare that I recognize that this o E. a a <br /> Information I am providing will be relied upon by the County of Burrett Wisconsin In determining whether to Issue a permit. I <br /> further accept all liability that may be a result of the County of Burrett relying on this Information I am providing in this q �k „ 6,;,,,-=N .a <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have A r) o o! c 8 r. <br /> access to the above-desalbed premises at any reasonable time for the purpose of Inspection. 6 w Na W t;„� n <br /> OWNER'S SIGNATURE , .0�� a o9a. c 8 o e S <br /> n 9 _ <br /> - (date) o a o c Q m E Z <br /> c <br /> ZONING ADMINISTRATOR a N > . 6 WS '1 <br /> '1 <br /> y � cw pt+1 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE H <br /> H u 8 0 0 0 8 <br />