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C O <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g W <br /> APPLICATION FOR LAND USE PERMITS y; <br /> OWNER � TELEPHONE 7�.5 - ,5�� <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT ❑ <br /> 0 <br /> COMMERCIAL BUILDING ❑ COM/ER'CIAL ACDD,IT/ION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: l`h' �J// o <br /> (Home/Cabin; Commercia Business; Bedroom; Deck`; etc.) n <br /> BUILDING CONTRACTOR: <br /> n <br /> O 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS G o <br /> WILL BE RETURNED. m <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. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW til w 3 <br /> BUILDINGS/STRUCTURES (NE), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, a <br /> AND INDICATE NORTH (N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S) TO ALL LOT LINES, (B) BUILDING($) g <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S) TO THE ORDINARY HIGH WATER MARK a55o0 <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. p Q) <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. I 1 <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: r, C• <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p <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. ogyanr) > U -0 <br /> n H 3 3 a [sl <br /> y 3 3 3 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 0,°�� v, ? w' <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all w� ' m <br /> Information contained in this application(Including any accompanying schedule)and I further declare that I recognize that this a S. e D to N <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to issue a permit. I w E: c, E:— a <br /> w <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this � '� 5 : ;,,�.,<- <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to <br /> N <br /> have access to the abov r I at any reaso ab�le�timm for the purp f Inspection. 6 o i wo ;4 zoi o g S r) <br /> OWNER'S SIGN URE (/f/ -� - �-dee B' o <br /> nc (date) c1 a? m r e c 2 <br /> ZONING ADMINISTRATOR \ /ll I I I.U.�I gkllI) 6 j g:v_, r ? 'n by <br /> • �� ' o o o f+f <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUAN � <br /> �(Yi`lf"�d'�P��J�IL'-�CQA' fif�0 �j �1l�Yhll.S �l/.�'L>° <br /> / � N p t�itin vii O <br /> to to O O O O O <br />