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Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a ° <br /> APPLICATION FOR LAND USE PER/MIT�iS �y 1:7 <br /> N � Z U� <br /> OWNER TELEPHONE `� _ a a-] - 3 / 6 � ; a <br /> 1rea <br /> 7 R <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS <br /> a'J�t 4 J /yjos r Dr ; v-e� o <br /> LEGAL DESCRIPTION 6L ulb ( <br /> TYPE OF PERMTr(S): SINGLLEE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ r <br /> o <br /> STRUCTURE/ADDITION USE: (�tOYAGG .ZOr 30� o <br /> (Home/Gobi , Commercial Business; Bedroom; Deck; etc.) �J <br /> BUILDING CONTRACTOR: S <br /> n <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz 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) a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. O <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, B <br /> AND INDICATE NORTH (N). Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) O d <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK Ql w' <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. S. <br /> 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., THE '� o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. , <br /> NOTE: NEEDEDLOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN _s <br /> BUILDING/STRUCTURE ," I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: �I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. C� n Z p <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 8 <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. <br /> 6. <br /> 7. >0005'apro <br /> I declare that this application(Including any accompafiying schedule)has been examined by me and to the best of my <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 <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. 1 <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 <br /> access to the above-described premises at any reasonable ime for the purpose of inspection. Em w a o o o y <br /> > o 0 0 0 o y <br /> na <br /> OWNER'S SIGNATUREEll y <br /> ZONING ADMINISTRATOR Q <br /> JUN 18 2012 a <br /> T WNSHIP PE ITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUAhu-C �T COU � N <br /> S000S <br /> ZONING <br />