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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> c z <br /> APPLICATION FOR LAND USE PERMITS . <br /> a <br /> OWNER1 {� TELEPHONE <br /> csftt'}, <br /> MAILING rRgSS <br /> �tJ9B vo Clr"wZ <br /> PROPERTY ADDRESS <br /> �o y�, — <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE y r <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 1 <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 S <br /> STRUCTURE/ADDITION USE: S - c <br /> (Home/Cabin; Commercial Bu ' ess; Bed m; Deck; etc.) <br /> BUILDING CONTRACTOR: ✓ r1 <br /> � y <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 hie X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS '� o <br /> WILL BE RETURNED. y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARTAL OR TOP VIEW) <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 t� O <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, v v <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) 'c P <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK _Z1 <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. O <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF),AND ALL DISTANCES 5 <br /> . r <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. .°. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. (1 i <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. I? J G <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBIECi TO ALL CONDITIONS LISTED BELOW: r- <br /> 1. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n z O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. b <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER C7 <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. ao0o8 cdfroil <br /> zN <br /> I declare that this application(including any accompanying schedule)has been ammirned by me and to rhe best of my g o � R.�_;1. <br /> knowledge and belief K is true,conned and compete. I adawwledge that I am responsible for the detail and amracy of all $ m R.I-e- a : -4 <br /> Information contained In this application(Including any accompanying sci edule)and I firntner declare that I recognize that this a `- 9 9 to N <br /> n" au <br /> Information I am proNdag will be relied upon by the County of Burnett Wisconsin len detwn**V whether to issue a permit I <br /> further accept all liability that may be a result of the County of Burnett relying on this kdaffrnation I am providing In MIs <br /> application. I agreeto permit qty of dais charged with adminishatlrg county ordinances or otherauahorbed person to have <br /> access to the abovedescribed pnynlses at any reasonable tame far the purpose of Inspection. <br /> ,� � �sgoss > <br /> [Q��\ <br /> OWNER'S SIGNATURE "'7" 7 <br /> ZONING ADMINISTRATOR �.h <br /> TOWNSHIP PERMITS MAY BE REQUIRED £ ^ " <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE o <br /> U U O O O O <br />