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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office g NND z <br /> APPLICATION FOR LAND USE PERMITS <br /> o <br /> OWNER % TELEPHONE <br /> MAILING ADDRESS v <br /> PROPERTY ADDRESS <br /> 11 �,,J�I C.t `( ' 16'/�f 5 n <br /> 4 <br /> P-rW 07—026 -.1 0—/6 - 3Z._ S ,•S— c9 5' -o ;� ��c; < <br /> LEGAL DESCRIPTION r" <br /> c c T 0 �C— 6 2 .5 —� "Z 3C� <br /> TYPE OF PERMIT(S): SIN E-F MILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> b <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ r" <br /> ` o <br /> STRUCTURE/ADDITION USE: I p;cZ c,e Lv G"S S/1 O W o <br /> (Home/Cabin; Commercial Business; Bedr m; Deck; etc.) <br /> BUILDING CONTRACTOR: O f 1— <br /> n <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS 2. <br /> WILL BE RETURNED. �r <br /> 121 <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) C7 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW to <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, (> c <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) ° <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK U <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. I b C�) <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES <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 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. S' 1 ❑ 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN Q <br /> aDj <br /> NEEDED. �-� <br /> � I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Ui r- <br /> x- <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <4'� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. n <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. <br /> NOT TO BE USED FOR HUMAN HABITATION. (1 <br /> 6. <br /> 7. ;0 D 9 <br /> 'Ell <br /> D oEi <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my c o <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all prZw v y <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this D Y Y to <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I a 'b <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 administrating county ordinances or other authorized person to have �r- <br /> access to the above-described premises at any reasonable time for he purpose of inspection. ° <br /> OWNER'S SIGNATURE % 6 Zo o' ~ <br /> n <br /> (date) o a o S c <br /> ZONING ADMINISTRATOR v IN a <br /> w � � <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE `�N <br /> � � 00000 <br />