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Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator � <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER -- • S, TELEPHONE <br /> C ds - a <br /> MAILING ADDRESS v !S-41r, <br /> o <br /> PROPERTY AD RES <br /> S y� r <br /> r.1 0;--� �1LC- rC ' a G o <br /> t <br /> LEGAL DESCRIPTION <br /> 1� ,, C DW ING/BUILDING 0 GARAGE/ACCESSORY STRUCTURE ADDITION Cl STAIRS [3c <br /> TYPE OF PERMIT(S): `� <br /> FILLING/GRADING 0 CAMPING UNIT CJ BUNKHOUSE 0 59.692(1V)GAZEBO 0 DECK 0 CD <br /> STRUCTURE/ADDITION USE: 60_kc�� <br /> c z <br /> (H a/Cabin; Commercial Business; Bedroom; Deck;etc.) o ° <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. � <br /> J <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> n vq a ^ <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 col <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, ' <br /> AND INDICATE NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES,(B) BUILDINGS) <br /> TO CENTERLINE OF ROAD,(C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> M <br /> (OHWM)OF LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. - z ` <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES r <br /> TO BUILDINGS, ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. n o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE a <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> 0 <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: b <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. <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 /> � 7bYnddd > d � <br /> 7. W`d• <br /> y �• o00 C p ! <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge a �,=? : <br /> and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information 4; p • <br /> contained in this application(including any accompanying schedule)and I further declare that I recognize that this information I to N <br /> am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I further accept all *I �0.- <br /> w g <br /> liability that may be a result of the County of Burnett relying on this information I am providing in this application. I agree to permit <br /> county officials charged with administrating county ordinances or other authorized person to have access to the above-described o <br /> bd cn <br /> premises at any reasonable time for the purpose of inspection. � � v� M <br /> .. � <br /> CD (��Q <br /> SIGN HERE t `► <br /> ni <br /> (si a re of o of building contractor) `O o Y A. <br />