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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a "3_ <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER TELEPHONE _ �� (�p � = o L� <br /> MAILING ADDRESS <br /> P, 3UX 55 a elaAer L-)T 51/ W2 � <br /> PROPERTY ADDRESS I F7 /I ''I L I (}J <br /> v W C.,l c: � <br /> a <br /> LEGAL DESCRIPTION ' J'I vl )w C <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING D ADDITION D DECK D GARAGE/ACCESSIO`lRY`S-(TRRUCTURE ❑ <br /> BUNKHOUSE D 59.692(1V)GAZEBO D STAIRS D FILLING/GRADING D CAMPING UNIT D I <br /> COMMERCIAL BUILDING D COMMERCIAL ADDITION D COMMERCIAL ACCESSORY STRUCTURED <br /> STRUCTURE/ADDITION USE: L'/ xO , 'z <br /> _ <br /> (Home/Cabin; ComRiercial Business; Bedroom; Deck; etc.) O <br /> BUILDING CONTRACTOR: Q <br /> n <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o j <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) � <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. G <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, a <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) l O <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 (DFp), AND ALL DISTANCES t <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 5 O y <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. nn^^ 1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE �R.J <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. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: O 7 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n z W <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. A <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. f <br /> 7. o 0 o Q a 0 7 <br /> n 333 an �' <br /> I declare that this application(Including an accompanyingschedule has been examined b me and to the best of m 3 0,°Z ^ <br /> PP ( 9 Y ) Y Y <br /> knowledge and belief It is true,carted 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 Nis 9 R E.a D <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit, t d S n a= a <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this v w " ;,,�„`- N IVV <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have ' w o <br /> access to the above-described premises at any reasonable time fo the purpose of Inspection. m 8 w N w n <br /> OWNER'S SIGNATURE �b C, '�° °'a <br /> oda= m�R�ez <br /> (date) g 5 Z <br /> ZONING ADMINISTRATOR `; c <br /> TOWNSHIP MITS MAY BE REQUIRED n $ <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N w <br /> 80008 <br />