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v ro Z <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> r <br /> APPLICATION FOR LAND USE PERMITS �^ <br /> y y ^ice <br /> O <br /> OWNER -;,y. I/ ) ,( f�F�� TELEPHONE <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS 2-7glfj <br /> LEGAL DESCRIPTION S' <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE'X rn <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> ro <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE 11 S' <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Businn�eess�s;Bedroom; 'OI <br /> BUILDING CONTRACTOR: rp <br /> (-0 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS p o <br /> WILL BE RETURNED. — c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. [ d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW 'b K a <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, a <br /> AND INDICATE NORTH (N). Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S) o O ? <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK �' C <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. d 000 <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES i <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. 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 W <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. t„ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: �^• C 3 <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. ,�—, Z <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 yl <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. Q <br /> /. > 000caro <br /> R n n 9 3 3 ? rt <br /> Eloo. �. r� <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all la P� EL E=' <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this `D E. yb7 N <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I v 5 a ao v 'a0 <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this 5 q : d,: �'+N b <br /> application. I agree to ' county officials chargedyy++ith admI Istreting county ordinances or other authorized person to _ E <br /> have access to the abov -descn re ises a ny Easo ble time for the purpose of inspection.. <br /> OWNER'S SIGNATURE__ <br /> (date) o yre i y <br /> ZONING ADMINISTRATOR�J ' laY ( /n on. <br /> Z' r^ ' •o .zI <br /> "1 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> ,THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> � o � 000 <br />