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G rn Z <br /> P � O <br /> a d <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> 6 <br /> OWNERJOA TELEPHONEFIgg ev/N 6YIjP 793j b <br /> (h' <br /> MAILING ADDRESS / 7^ w/C //(•j O oQ O 5 <br /> PROPERTY ADDRESS / a <br /> ( r C <br /> LEGAL DESCRIPTIONLDT <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE ❑ 2 <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ ti <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ U '� <br /> STRUCTURE/ADDI0 RON USE: W <br /> I ome a In;LOMmercial ousmess;Bedroom; Deck;e . V <br /> BUILDING CONTRACTOR: ,h 3 <br /> O <br /> � o <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <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. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW a '(� <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, i <br /> AND INDICATE NORTH(N). pZ <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) S� I <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. qJ O <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES n y I <br /> TO BUILDINGS,ROADS,LAKE,LOT LINES. _ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE (I) <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. i <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: U� x <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. <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 l/� <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. ac oow nb 'd <br /> A c 'E Cy <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belie!It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all <br /> Information contained in this application(Including any accompanying schedule)and I further declare that I recognize that this _. D m Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I ? a = "ad <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this 'c T B d, .,` N b <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to C, <br /> have access to the above-de 'bqd premisesilt any reaso r the purpose of inspection. D g t"'A .,,, n <br /> / A ga <br /> OWNER'S SIGNATURE 3/ �C` 3 tie o g 8 o g o-y. <br /> (date) <br /> ZONING ADMINISTRATOR i Par _ o-2. o <br /> m C : F ii Cil <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> O <br /> ��= pir1� s <br /> Jn U O p O <br />