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N b z <br /> a o <br /> Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator a 3 <br /> APPLICATION FOR LAND USE PERMITS <br /> a <br /> OWNER /. ( � TELEPHONE <br /> V" <br /> MAILING ADDRESS /' r n 1 �l,k 2 L DW) <br /> PROPERTY ADDRESS ^ O (}J <br /> LEGAL DESCRIPTION <br /> ti <br /> TYPE OFPERMIT(S): SINGLE-FAMILY DWELLINMA ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO❑ STAIRS❑ FILLING/GRADING ❑ CAMPING UNIT❑ I� <br /> CAW <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: <br /> ome aCommercial mess; room; Deck;etc.-y- Ri 'rD <br /> n <br /> BUILDING CONTRACTOR: 44 C <br /> � c <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. (' <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) C dU <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW O G o <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, ' 3 <br /> AND INDICATE NORTH(N). N Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGS) Q <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK v O <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 ti <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 VERIFICATION MY BE DONE WHEN �—! <br /> NEEDED. H }� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. .! n Z O Q <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. Uj <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. V <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. p <br /> NOT TO BE USED FOR HUMAN HABITATION. C, <br /> 6. p <br /> 7. 77DnnnC) > U -0 <br /> a, <br /> Fr' 333 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my S. <br /> 0 R <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all S. <br /> Information contained In this application(including any accompanying schedule)and I further declare that I recognize that this f° E. 9 <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I 'a, n E: a <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing in this w � s9 .roq <br /> application. I agree to permit county officials charged with administrat g county ordinances or other authorized person to O ,.. <br /> have access to the abovrdescr' ed prero_ise t any reaso le ' the urpos inspection. m D s9 g <br /> OWNER'S SIGNATURE 3 m S S g- - , 88 <br /> H <br /> ZONING ADMINISTRATOR I n Fta�l an <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ON YEAR FROM DATE OF ISSUANCE o <br /> beam ll?I EerP�cKe r1P b� /fear off { he NorN, 9 �3-�l d` � : = 22 <br /> (A� pN UfR EAO <br />