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z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g � <br /> APPLICATION FOR LAND USE PERMITS o y <br /> OWNER TELEPHONE ' a <br /> R' <br /> Uio� (�A/UIS� s <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS LA I�I� Je ✓lr . ° <br /> LEGAL DESCRIPTION I o f e s m Vol <br /> �1() <br /> TYPE OF PERMITS): SINGLE FAMILY DWELLING ❑ ADDITION ❑ DECK 0 GA h-/ ACCCCE(S90RY STRUCTURE <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ q <br /> u <br /> COMMERCIAL BUILDING ❑ COMMERCIA ADDITION NO COMMERCIAL ACC/E-SSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: C—P' ��r� j/O U/ ° z in <br /> � ) o <br /> (Home/Cabin; Comme tial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: Se n <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C 0 <br /> WILL BE RETURNED. rn <br /> DIREC IONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) (� a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C <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, o <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 w5 O <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. ty <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES CJ• <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 3.6. w I <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.,THEo <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 0 <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: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n <br /> z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. — F <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 <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. E <br /> 6. <br /> 7. o 0 0 a <br /> 1 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. 1 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 > >2 <br /> N <br /> Information I am provldlnq will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit I 4 w a <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing In this c C <br /> application. I agree to permit county officials charged with adml ting county o Inances or other authorized person to have n,°p <br /> access to the above-described premises at any ran able tlm the purposa of 1 on. m w a o`w�' W 'A f1 <br /> < <br /> OWNER'S SIGNATUR&c <br /> gv, n0 <br /> (date) <br /> ZONING ADMINISTRATOR <br /> � 6 <br /> TOWNSHIP PERMITS MAY BE REQUIRED ^ "° <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ^o <br /> ao-/ <br />