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Burnett County 7410 County Road 21 C�MPUTER/SCANNED <br /> o. 02, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS f; <br /> OWNER TELEPHONE 7 <br /> o <br /> MAILING ADDRESS �� r � � 3 <br /> I <br /> PROPERTY ADDRESS <br /> 0 <br /> LEGAL DESCRIPTION / <br /> I ( <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLIfqG ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ i <br /> a <br /> 3 <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ a <br /> COMMERCIAL BUILDING ❑ CCOMME�RCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ 0 <br /> e <br /> STRUCTURE/ADDITION USE: S'4 rC —,/ /., Y_ � / z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: .tJi ( !c�(yL—c-^- <br /> r± i <br /> -r <br /> C i i <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS c <br /> WILL BE RETURNED. .L, II _ <br /> n IIII 1 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C y <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW Cn <br /> 1= <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) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK r' <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES j <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. f. j <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 9 <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 I I <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: / <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.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 /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. I <br /> NOT TO BE USED FOR HUMAN HABITATION. ` <br /> 6, c <br /> 7. n > > <br /> C_ i7 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my Z r <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all _ =' <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this c > > <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I c 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 /> application. I agree to permit county officials charged with administratin county ordinances or other authorized person to have <br /> access to the above-described premises at any reasonable time for the,p rpose of Inspection. <br /> J a <br /> OWNER'S SIGNATURE <br /> (date) n 6s > <br /> ' <br /> ZONING ADMINISTRATOR J <_ E. 5 <br /> rt i t=7 <br /> TOWNSHIP PERMITS MAY BE REQUIRED ^ ' <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OFJA 2 32009 <br /> BURNETT COUNTY <br /> ZONING <br />