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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS y �; <br /> p T <br /> OWNER Qu� � i L IF Cr f M l'/) TELEPHONE 717 <br /> a O �t <br /> MAILING ADDRESS <br /> ayOE�l7 C nr 55'8 3 Rev , ; <br /> PROPERTY ADDRESS t� /��" /. <br /> LEGALS�IU � E V� LI SJJ k�l',F�N—C f�l,(f�7-5VN <br /> TYPE OF PERmrT(s): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK❑ GARAGE(ACCESSORY STRUCTURE)(( <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO O STAIRS❑ FILLING/GRADING❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL(ADDITION ❑ OMMERCIJAL ACCESSORY STRUCTURE O <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) P 1 <br /> BUILDING CONTRACTOR: n <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o_ <br /> WILL BE RETURNED. <br /> R <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) r o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW Iwo 'O 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, a <br /> AND INDICATE NORTH(N). N o <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 <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. p <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. 2 rn <br /> S. 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 Di <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. KO <br /> O <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: r I( p <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS.OF PERMIT. n Z (D W <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> SETBACK AREA. <br /> r <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 /> I (� <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. E <br /> 6. <br /> 7. 2 o e ro <br /> $ n � 3 3 3 M <br /> 3 3 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my reo <br /> knowledge and belief it Is to ,canect and complete. I acknowledge that I am responsible for the detail and accuracy of all o <br /> Information contained in this application(Including any accompanying schedule)and I further declare that I recognize that this <br /> information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I .� $w v 9V <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing in this N <br /> application. l agree to permit county offIdals charged with administrating county ordinances or other authorized person to have „,� : 88 <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. m w 'A W N w n <br /> OWNER'S SIGNATURE_ to n m+:O <br /> (date) ,� <br /> Tim FlC�nrc�h y w am <br /> ZONING ADMINISTRATOR � a � ?. � <br /> TOWNSHIP\PERMITS MAY BE REQUIRED O <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF/ISSUANCE 9 .1;1N» +» <br /> P� -(i�Gfi,l/�J <br /> P�r6+ Sas-o9 <br />