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z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS H <br /> OWNER //� o ) /// TELEPHONE <br /> /,` d 6 // /� /rte/ O J y/ 0 <br /> MAILING ADDRESS 17e / (J ,�n <br /> ° <br /> PROPERTY ADDRESS - <br /> a1lTP <br /> LEGAL DESCRIPTION r <br /> _ o <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE Ur <br /> 5 <br /> BUNKHOUSE ❑ 59.692(IV)GAZEBO ❑ STAIRS❑ FILLING/GRADING ❑ CAMPING UNIT❑ �F <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL CCESSORY STRUCTURE ❑ <br /> n <br /> 0 <br /> STRUCTURE/ADDITION USE: C3,51✓ C Z � - <br /> 0 <br /> (Home/Cabin; Com tial Business; B Broom; Deck; dtc:) <br /> BUILDING CONTRACTOR: f <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 C o <br /> WILL BE RETURNED. <br /> m � <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. C <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW lyn 'O 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, .. a <br /> AND INDICATE NORTH(N). c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDINGS) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK w <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND (D)LOT DIMENSIONS. p <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTANCES q <br /> TO BUILDINGS, ROADS,LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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 /> ti <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r- nn ll <br /> � w <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Y <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. B a <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 /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. ^ fie ag�g ��npappro <br /> I declare that this application(Inducing any accompanying schedule)has been examined by me and to the best or my <br /> knowledge and belief It Is true,correct and complete. I acknowledge that i am responsible for the detail and accuracy of all m= d m a y <br /> Information contained in this application(including any accompanying schedule)and I further declare that I recognize that this <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. 1 o.g .'n w< : aro <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this <br /> application. 1 agree to permit county officials charged with administrating county ordinances or other authorized person to have ,2 G <br /> access to the above-described e t;V so abere u of Inspection. w 9 u f1 <br /> OWNER'S SIGNATU >?gym,�n 9�jpvp'�,++rr0 <br /> ,g ° o � <br /> � O� [+1 <br /> ZONING ADMINISTRA R y�„ : °w <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE » ^N «» <br /> e✓m� � lef�e� malW fo 0)1Ffyd Mak -ao-o9 $0005 <br />