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b z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g ° <br /> APPLICATION FOR LAND USE PERMITS <br /> s' <br /> OWNER � oT� TELEPHONE <br /> C _12/(// d <br /> V <br /> MAILING ADDRESS .J <br /> T Z"0 Iz kes AALi- 55-o!; 6 <br /> PROPERTY ADDRESS, a <br /> LEGAL DESCRIPTION -- <br /> 0 <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTUR n <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ S <br /> STRUCTURE/ADDITION USE: - eL ° z <br /> (Home/Cabin; Comm rcial Business; Bedroom; Deck; etc.) ° <br /> BUILDING CONTRACTOR: � pp <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS V' o�CN <br /> WILL BE RETURNED. _ <br /> Z n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C <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, v a <br /> AND INDICATE NORTH (N), i <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 <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. <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 ^ o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIC,pTION MY BE DONE WHEN W <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> (n S <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �I <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. ICo I a <br /> 7. �1aTY� r Sac <br /> aao2 <br /> 9 3 = o <br /> "F Z o ,m, � 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� ? <br /> knowledge and bellef It Is true,correct and complete. I acknowledge MB c wat I am responsible for the detail and accuracy of all El <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 Burnett Wisconsin In determining whether to issue a permit. Iw ? a '= Y <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this 'y� y <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have c ,°� c o o o <br /> access to the above-described preml t any reasonable Id or It purpose pectlon. m <br /> 60p00 <br /> OWNER'S SIGNATURE ��_ A >o. <br /> ate <br /> a o' O = 'Z <br /> ZONING ADMINISTRATOR H o', 5 n <br /> �o C wF3 tl <br /> OWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PER SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N o N N o <br /> � � 00000 <br />