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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 <br /> N � 1 <br /> OWNER �✓�� P� TELEPHONE a <br /> Frep P/-Cie./- <br /> d <br /> v <br /> MAILING ADDRESS `� o <br /> � d s <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTIONr <br /> O ° <br /> TYPE OF PERMIT(5): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDI N ❑ COMMERCIAL ACCESS RY STRUCTURE ❑ N c <br /> STRUCTURE/ADDITION USE: f ! <br /> (Home/ abin Commercial B ess; Bedroom; De k; etc.) <br /> BUILDING CONT OR: <br /> A PLOT PLAN BE PROVIDED ON AN 8 rfl X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS 't <C) <br /> WILL BE RETURNED. p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. r <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, n. o <br /> AND INDICATE NORTH (N). <br /> SHOW DIMENSIONS IN FEET OF THE FOLLOWING: C c <br /> 3. OWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) p) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 2 5' <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. d m C) XJ <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 o <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 G <br /> C) <br /> NEEDED. � <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> r <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. d 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 V <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. d <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. C <br /> �. a 77 > cocoa0ro <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 0 g ' m d �O '••' <br /> Information contained in this application(Including any accompanying schedule)and I further dedare that I recognize that this 5. a a m ti <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I a c c n: Y <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 /> rn <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person[o have <br /> access to the above-described pre sat any reasonable time for the purpose of Inspection. <br /> ' ..� C9 w aowwNw <br /> OWNER'S SIGNATURE `/��-�/�4�" S - Z.f/( Z Art > > <br /> �OV <br /> ZONING ADMINISTRATOR /^ .� � : 0 D <br /> TOWNSHIP PERMITS MAY BE REQUIR MAY 8 2012 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE SSUANCE <br /> BURNETT COUNTY <br /> ZONING <br />