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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a z <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER 6� TELEPHONE eb�� WnO� v)b'(so a U1 <br /> O LU <br /> u <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS <br /> �i 4� Bess LCi �e <br /> n <br /> LEGAL DESCRIPTION <br /> o <br /> TYPE OF PERMR(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE n <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ I S <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ S' A <br /> STRUCTURE/ADDITION USE: Z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) IUI a <br /> BUILDING CONTRACTOR: <br /> n <br /> O3 C>IZ <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 '/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o Q <br /> WILL BE RETURNED. _ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 9..1c <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 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 9 <br /> AND INDICATE NORTH (N). n` <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS) TO ALL LOT LINES, (B) BUILDING(S) c X1 C o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 5' <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS.' <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. 9 <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 I o c <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: I_ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. F <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. a W <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. n <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. C I <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. � <br /> 7. <br /> ^ roan�nc� a y <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of myc <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all a 2 <br /> d' <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 Burned:Wisconsin in determining whether to Issue a permit. I <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 N r <br /> access to the above-described premises at any reasonable time for thepurposeof Inspection, o w � $ o : S 8 .. <br /> i� <br /> OWNER'S SIGNATURE 1161 = A 6 6 N m O <br /> w a w <br /> (date) U. <br /> 9 'a <br /> ZONING ADMINISTRATOR ,'V �o " <br /> • rt C i v 'w t21 <br /> TOWNSHIP PERMITS MAY BE REQUIRED C' <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSU NC <br /> 6� ''hr� / Z) <br />