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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator c <br /> APPLICATION FOR LAND USE PERMITS g �. <br /> / / o <br /> OWNER TELEPHONE �M G _ 76 <br /> MAILING ADDRESS � ?k74-) <br /> PROPERTY ADDRESS <br /> �o <br /> LEGAL DESCRIPTION 6U /. LOT <br /> DWELLING/BUILDING 13GARAGE/ACCESSORY STRUCTURE 13 ADDITION ❑ STAIRS ❑ S <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ �C^/AMPING UNIT❑ BUNKHOUSE ❑ 559..692(1V)GAZEBO O DECK❑ <br /> STRUCTURE/ADDITION USE: ��L s /�/��/7� f �p <br /> / (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) c P <br /> BUILDING CONTRACTOR: [ <br /> r <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 y2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS m c <br /> WILL BE RETURNED. QdteS �• %is 0� � I^ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 6 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW c <br /> BUILDINGS/STRUCrURES (NE), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, tyn <br /> AND INDICATE NORTH (N). ..� <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) IW n <br /> TO CENTERLINE OF ROAD, (C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM)OF LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 'z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTANCES r a <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. n E E <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE <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 /> m <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> a <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. <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 <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. <br /> 7. A ro�ro <br /> �98� ; =' 3 <br /> I declare that this application(including any accompanying schedule)has been examined by me and mi-4 best of my knowledge y C k <br /> and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information e ' <br /> contained In this application(including any accompanying schedule)and I further declare that I recognize that this Information I Y <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit I further accept all" V <br /> liability that may be a result of the County of Burnett relying on this Information I am providing In this application. I agree to n u 8 <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to dee above- S <br /> described premises at areasonable time ler the pu o!InspacWn. r m <br /> P3G aT= tj <br /> SIGN RE <br /> na re of" buikll contractor) ( ) c� Z s y_ z <br /> ZONING ADMINISTRATOR Z 41 <br /> LU <br /> y H N V g w <br /> 7 ^ ate <br /> O; <br /> TOWNSHIP PERMITS MAY BE REQUIRE¢ILJRNETT COUNTY <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE tSFF I SG v N s a o <br />