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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator O o <br /> APPLICATION FOR LAND USE PERMITS <br /> G' <br /> � n <br /> OWNER- TELEPHONE -)Q <br /> d <br /> (OBJ Q m <br /> n <br /> MAILING ADDRESS <br /> n <br /> PROPERTY ADDRESS <br /> LV OL" <br /> LEGAL DESCRIPTIONV,J._���. q/��51� �N A < J <br /> SINGLE AMI DWELLING O GARAGE/ACCESSORY STRUCT RE 0 DDITION 11f STAIRS ❑ 5 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ PING UNIT BUN USE ❑ 9.692(1V)GAZEBO ❑ DECK O <br /> Aa{r�IClon �°�O <br /> STRUCTURE/ADDITION USE: Z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) 0 o <br /> 3' <br /> BUILDING CONTRACTOR: O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS y <br /> WILL BE RETURNED. <br /> 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. tf i'i <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW C <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, to <br /> AND INDICATE NORTH (N). <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 G0 3 <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. N w a o <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. <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 <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: O O <br /> r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ' ip <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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. <br /> 9 <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge .z w ! y <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information v 0 E•; <br /> contained In this application(including any accompanying schedule)and I further declare that I recognize that this Information I w=«N N b <br /> am providing will be relied upon by the County of aumett Wisconsin In determining whether to Issue a permit. I further accept all v_!�N 8 N N g r <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 g <br /> permlt county officials charged with administrating county ordinances or other authorized person to have access to the above- 5 Ij <br /> described premises at any reasonable time for the purpose of In Rion. _ o-_ <br /> OWNER'S SIGNATURE - c on ��.F. a <br /> ate Hf %Eaw t�9 <br /> ZONING ADMINISTRATOR i! F 4 CIAW <br /> uLi <br /> TOWNSHIP PERMITS MAY BE RE ED <br /> I bl <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATEORka 1TFff c INS v g <br /> �4- (e.Hez- fyui M , v ZONING <br /> 1 L4rhdnf 9-ly-61? <br />