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Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS <br /> a <br /> OWNER TELEPHONE., <br /> ...phi, u✓ � ���/�✓ � <br /> w <br /> -9 p <br /> MAILING ADDRESS � � <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION/J� <br /> TYPE OF PERMIT(S). SINGLE FAMILY DWELLING K GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: —� '_ <br /> (Homy/Cabm; C mmercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: °— <br /> — n <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. s,I <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 w <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, 3 <br /> AND INDICATE NORTH (N), c <br /> GIN <br /> o <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 5' J <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. d <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. 5. <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 7 ,Li -0 <br /> 0 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 7 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN y <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r„ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. � z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. a <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER — <br /> SETBACK AREA. r <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. T <br /> NOT TO BE U ED FpR H_UM,Ary,HABITATION. <br /> 6. h <br /> Sef �r <br /> 7. J ''Z1 � 0 0 o <br /> xzo � � o <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my p o wo <br /> 3 =.E r <br /> knowledge and belief it is[rue,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all � � m � m <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this �. 907o <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I w c e n 'a I a <br /> further accept all liab� at be a result of the County of Burnett relying on this information I am providing In this w'yO q n b <br /> application. I agre to permit co ty officials charged with administrating county ordinances or other authorized person to CI E o i o o .r„ <br /> have access to the ove-descr d premises at an reaso bl time rpose p Ion. o � y o <br /> AQ _�w�w� <br /> OWNER'S SIGNATUR /O 6 O 3 9 2 o0 00 0 0 0 > <br /> (date) m o.�o <br /> To <br /> ZONING ADMINISTRATOR .telo; <br /> 0 mow' : Spt+] <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> tin N O O O O O <br /> to O O <br />