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c A c <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrato g <br /> APPLICATION FOR LAND USE PERMITS H y <br /> a <br /> n <br /> 6 <br /> OWNERn i c Gael �-���, �� In TELEPHONE <br /> Lem .. O <br /> MAILING ADDRESS I ( b ai I O4h _S4- <br /> I hre sso r WT- <br /> 5 ,I )aq <br /> PROPERTY ADDRESS c ' <br /> Clam Shell Lr) <br /> LEGAL DESCRIPTION <br /> y <br /> TYPE OF PERMIT(S): — <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ STAIRSCF <br /> FILLING/GRADING ❑ CAMPING UNIT <br /> C BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑US <br /> STRUCTURE/ADDITION USE: 1 • "-' a y I ' .} <br /> (Home/Cabin; Commercial Business; Bedroom; beck; etc.) c <br /> O <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN B Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLAN O 3 Q p <br /> WILL BE RETURNED. C o_ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. en•1 + <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW ^ O 7' <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). 1 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) n, 1. <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK °e R <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. R. �A <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (DF), AND ALL DISTANCE p X <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. fi — <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ff. v: p al <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE c I <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 <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. ")( <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. (7 J) <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. (n z <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER Ix <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW.FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY C <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. Q <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge a7 Q D O b <br /> and belief It Is true,correct and complete. I acknowledge that i am responsible for the detail and accuracy of all Information N v_ IT c <br /> M <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this information I <br /> am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all " y <br /> liability that may be a result of the County of Burnett relying on this information 1 am providing In this application. I agree to R <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- n C:) <br /> described premises at any reasonable time for the purpose of inspection. <br /> OWNER'S SIGNATURE // e m w y s ±+ > <br /> .� -- (date) n n 5. .q <br /> le <br /> ZONING ADMINISTRATOR <br /> O J/ by.y67 <br /> 6 qq t'h <br /> TOWNSHIP PERMITS MAY BE REQUIRED �t <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE O [ <br /> one, <br /> TmitT aN g W U N <br /> efi-n� er, f�va PdTc�s <br />