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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator & <br /> APPLICATION FOR LAND USE PERMITS V 1 w <br /> OWNER TELEPHONE L1!6B 13 Gq <br /> MAILING ADDRESS �° d <br /> I i n <br /> PROPERTY ADDRESS / S L/cj <br /> k9 <br /> > <br /> LEGAL DESCRIPTION <br /> J-F I (Q ctj ° + <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE rn <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL <br /> STRUCTURE/ADDITION USING EJ COMMERCIAL ADDITION n COMMERCIAL ACCESSORY STRUCTURE ❑ a <br /> �o �t BARn) ' Vim/+ <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: e I <br /> n <br /> �r y <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Y:X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> A a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. to <br /> a <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, ,v6 <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 �' <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. C <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE \ c <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED, y O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: pOl <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Iv N <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. <br /> SETBACK AREA. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER B <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. v <br /> 6. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> F <br /> 7. <br /> �y > a ro <br /> I declare that this a F ^ �^ 9 3 Cr n <br /> application is true, <br /> ,co" Ing and <br /> acmete. I ac schedule)has!Main respor lb of r t and to the beat d z " A n o o �. <br /> knowledge and bend lt !true,convert and canPkte. I ahiThoMAedge that I am responUbk for the detail and amrcacy d all <br /> B e m = ? m <br /> Information Iam provinediding <br /> Ing ill be atlon(including any accompanying schedule)and I further declare that I <br /> further <br /> acInformation I am preWding will a rNkd upon by the County d Bumatt Wisconsin in determining whether to imsiera Permit IB <br /> /urther aCtlpt all liability that may be a result of the County d Burned raying on this Information I am providing In this <br /> application. I� �couety melswith ���y ordinances or athr aWwrDed Person to have ^ c o o"�' g S tro" <br /> access to the premises at <br /> purpose d khsyehdfon. � n � >g S o 0 8„a1„ <br /> OWNER'S SIGNATURE R <br /> A n <br /> (date) o ce >o m n rnn x <br /> ZONING ADMINISTRATOR S o ? - <br /> TOWNSHIP PERMITS MAY BE REQUIRED e <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> pN IR y,69 p� <br /> V V O O O O O <br />