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Burnett County 7410 County Road K, No. 102, Siren,WI W72 Office of Zoning Administrator g <br /> 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> G <br /> owNERP tfy � /F ��o� tELEPHONE 7iS- PLL- NZo C 3 <br /> a 1 Y C .�C. I <br /> MAILING ADDRESS . r • .L� <br /> I <br /> PROPERTY ADDRESS IV �t•0,4 /ayr �_/ �e <br /> LEGAL DESCRIPTION / O O Q <br /> TYPE OF PERMfT(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE 0 <br /> BUNKHOUSE 0 59.692(IV)GAZEBO 0 STAIRS O FILLING/GRADING 0 CAMPING UNIT 0 ,Z <br /> v <br /> COMMERCIAL BUILDING f7 dCOMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE C1 <br /> STRUCTURE/ADDITION USE: :S4'e 1 o <br /> (Home/Cabin; Commercial Business; Bedroom; Dack; etc.) <br /> BUrLDINGCONTRACTOR:,& b/ <br /> O ; <br /> A PLOT PLAN MUST BE PROVIDED ON AN B Ih X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. r <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. _ e <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, v <br /> AND INDICATE NORTH (N). rr z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) 3 P <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(DF),AND ALL DISTANCES _ <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> $. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 91 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THESu <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. Y-� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUMECT TO ALL CONDITIONS LISTED BELOW: <br /> 1, DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. '] Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Pd p <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 1 <br /> SETBACK AREA. U 1I <br /> ONLY. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE <br /> NOT TO BE USED FOR HUMAN HABITATION. g <br /> 6. <br /> D ' <br /> 7. ' ° OI"I <br /> L` 7,'83 nim A <br /> 1 dedare that this application(Including any accompanying adhodule)has been otamined by me and to the best of my a ..22 7. 8r. <br /> knowledge and belief a le true,correct and camPlete. I acknowledge that I am responsible for the detail and accuracy of all W'== a <br /> Infomnation contained In this application(Including any acoompany ng schedule)and 1 further declare that I recognize that this `- " > = i y <br /> Inforrm <br /> nation I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to issue a pek. I `+ .L`'r, <br /> further accept all liability that may be a result of the County of Bumett relying on this Information I am providing In this 6. <br /> application. I agree a permitcounty officials charged with adminwoummuriLyordkun or other aauwfted person to have B <br /> access to tin above-described prembin at anY reasonableare for the of bapeclon. v M Y <br /> � RI <br /> s n v C <br /> OWNER'S SIGNATURE T s (date) W O <br /> , 2 <br /> V / <br /> Z <br /> ZONING ADMINISTRATOR,_ <br /> TOWNSHIP PERMITS MAY BE REQUIRED 3 `: <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF MOW Ig2�09 U s 8 0 0 0$ <br /> BURNETTCA) NW <br />