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C A p <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER TELEPHONE <br /> MAILING ADDRESS 12 <br /> L�7 2 <br /> PROPERTY ADDRESS �j _vc� 54z-v,--O5 <br /> LEGAL DESCRIPTION e <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ADDITION O DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> v ' <br /> COMMERCIAL BUILDING ❑ C M ERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ 0 3 <br /> STRUCTURE/ADDITION USE: c <br /> (Hme/ in; Commercial B ness; Bed om; D ck; etc.) <br /> BUILDING-CONT CTOR• n <br /> A PLOT PLAN MUST B P OVI ED ON, <br /> B Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS G o <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. y <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW rn " <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 3 a <br /> AND INDICATE NORTH (N). N ( c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) $ <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK a; <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. pjj <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. �' h <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. r^� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE l� o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN ..i <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: N <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. R <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. a S (\ <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. \ <br /> NOT TO BE USED FOR HUMAN HABITATION. 1 <br /> 6. — L <br /> 7• z � �o0o adb <br /> xzo 33 ;^ F. <br /> n 'o' o <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 0 ,� P � R.�? w <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all $ <br /> rlZ4 Information contained in this application(Including any accompanying schedule)and I further declare Nat I recognize that this n°JN > <br /> Information I am providing will be relled upon by Ne County of Burnett Wisconsin In determining whether to Issue a permit. It. <br /> further accept all liability Nat may be a result of the County of Burnett relying on Nis Information I am providing In this c `_'N c <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have Z $ o ,.. <br /> access to the above-described premisesatany reeaassoonnnakfie time for Nge purpose of Inspection. 8 w, Y <br /> OWNER'S SIGNATURE a m n Hn O <br /> c+ a <br /> /�� <br /> (date) <br /> w Iya 5 <br /> ZONING ADMINISTRATOR 4('i i ��(M• 6'L �C1,�1 a�„ E (e, <br /> ZONING <br /> TOWNSHIP PERMITS MAY BE REQUIRED ; <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISS�SUANCE('_ <br /> l ��dl 1,4,� �lir (l�1/e ✓�" �,(��l)� ��8 0 0 0 8 <br />