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n 0 <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0, <br /> APPLICATION FOR LAND USE PERMITS N - <br /> � n <br /> OWNER ,t,J �2 TELEPHONE <br /> MAILING ADORES �O� `�/>> /�•Z IfC r <br /> !/!s`G//it/�et <br /> PROPERTY ADDRESS T ��' <br /> Lir- <br /> 6EGA6-DESGRIPTICN , <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITIOV STAIRS ❑ <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO J6 DECK ❑ .a <br /> r ° <br /> STRUCTURE/ADDITION USE: k Oj <br /> (Home/Cabin; Commer lal Business; Bedroom; Deck; etc.) c <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. C o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW tid Ir n <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). p <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (6) BUILDING(S) N o <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. M5 r� <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTANCES p <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S INL'iG"..'c I „WALiOUT 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 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. I I) <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. n C <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 A G <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FO�R�PRIVATE RESIDENTIAL GARA�G // <br /> .ESTORAGE ONLY. <br /> NOT TO BE USED FOR <br /> l� <br /> . Ck -D I�UA./-Lc 4- HUMAN <br /> HABITATION. <br /> 4 6 . l"W f.1� <br /> 7. <br /> i+ 7y r]Q1 D C b <br /> 1 dedare that this application(including any accompanying schedule)has been examined by me and M the best of my knowledge <br /> and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information <br /> contained In this application including any accompanyingschedule and I further declare that I recognize that this Information I <br /> PP ( ) 9 3 p �ao Baa <br /> am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I further accept all C <br /> liability that may be a result of the County of Burnett relying on this Information I am providing In this application. I agree to <br /> permit county officials charged with county ordinances or other authorized person to have access to the above- <br /> administrating w O•-�^.�� � � ,,, <br /> described premises at any reasonable r the purpose of In o N U c <br /> OWNER'S SIGNATURE n o E:Y <br /> (date) n : g " O <br /> ZONING ADMINISTRATOR an-) <br /> �: asap <br /> TOWNSHIP PERMITS MAY BE REQUIRED G <" <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE r <br /> Peai <br />