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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER % / TELEPHONE <br /> w <br /> r O <br /> MAILING ADDRESS Z��� <br /> C� J � ° <br /> z <br /> PROPERTY ADDRESS c \ <br /> LEGAL DESCRIPTION S C <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITIO DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING ❑ COpaMERC/ IAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURED <br /> �s��y/1!) <br /> STRUCTURE/ADDITION USE: �M7 ) .z <br /> ( ome/Cabin- Commercial Business; Bedroom; Deck; etc.) ° <br /> BUILDING CONTRACTOR: O W X11 Z <br /> n <br /> o � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/1 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) r) w. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. q wb <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, 9 <br /> AND INDICATE NORTH (N). p <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 <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. A) <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. S. w <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 / y <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> C)�-y �J I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n <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. A <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. <br /> 6. <br /> 7. Mels of VV#6uw Fair madkef Volm r 6e -Ik- 9Z, 2V°° gaw Mar4{ ga, 'A ,24,C/4ny,, 7y a nap p <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 an mplete. I acknowledge that I am responsible for the detall and accuracy of all - n• .`�° y <br /> information contained in this applicatio u n ccompanying schedule)and I further declare that I recognize that this `° e <br /> Information I am providing will be r y t unty of rnett Wisconsin In determining whether to Issue a permit. I w a c n E"N : i Y <br /> further accept all liability that may It o umett relying on this information I am providing in this w ' 8 c <br /> c �° 4. : ss <br /> application. I agree to permit cou y s ar ith inis[rating county ordinances or other authorized person to G: �, ^' g c r" <br /> have access to the above-descrl mise as a time for the purpose of insp�e °n. S I; <br /> OWNER'S SIGNATURE �1 /14I)zt,) 3 c $ 0 0 0 <br /> _ (,/date) n by a,� <br /> ZONING ADMINISTRATOR I.LrQQ/ltL ZO�a � �o' �5 <br /> cw W n [i7 <br /> (4 C F y <br /> TOWNSHIP PERM MAY BE REQUIRED _. <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> o : <br /> vt n 0 0 0 0 0 <br />