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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administmtor n z <br /> APPLICATION FOR LAND USE PERMITS �. <br /> OWNER C) e- TELEPHONE <br /> F �O <br /> MAILING ADDRESS p V Til l�31 -3 / r )� � (J� <br /> PROPERTY ADDRESS I vT/1 1 `(V <br /> l: <br /> LEGAL DESCRIPTION w <br /> 5 <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ STA RS ❑ o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING0 CAMPING UNIT ❑ BUNKHOUSE El59.692(1V)GAZEBO ❑ DECK ❑ <br /> STRUCTURE/ADDITION USE: IS y- i Z n <br /> (Ho%CaYV Commercial Business; B room; Deck; etc.) o P <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Ya X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS rnii <br /> WILL BE RETURNED. O 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. tnf a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW y <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDI G(S) c <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK a <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D)LOT DIMENSIONS. N <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTA 4CES w c <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. d W c <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE a <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. S <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE W EN (� <br /> NEEDED. r' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 0 <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 010 <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. Z Q <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE C NLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. E <br /> 6. <br /> 7. <br /> w <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowle Jge <br /> and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information e g <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Infomnatlof i I <br /> am providing will be relled upon by the County of Bur tt WiscoreI In determining whether to Issue a permit. I further acce all <br /> liability that may be a result of the County of Burne lying on this Information I am providing in this application. I agree to OCA <br /> permit county officials charged 5ating u ordinances or other authorized person m have access to the above described premises at any mawr th action. to ;3OWNER'S SIGNATURE c w !(tlate) � sn �ZONING ADMINISTRATORim Mani n Fl o <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> Vf 4f: <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE GN 8 U o <br /> pern irk le-I 4e� pickeo( u f boy 0la- rneL' -l�o� <br />