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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a. 3 <br /> APPLICATION FOR LAND USE PERMITS <br /> I� fi <br /> OWNER !L �� II� � Ce I hl'llpS T(�l TELEPHONE p <br /> MAILING ADDRESS <br /> VSO <br /> � <br /> PROPERTY ADDRESS <br /> C <br /> LEGAL DESCRIPTION b '_S� U <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DEC GARAGE/ACCESSORY STRUCTURE O / <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ j <br /> I � � <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDTfION USE: iJl <br /> (Home/Cabin; C mmercial Business; Bedroom; Deck; etc.) I `, <br /> BUILDING CONTRACTOR: rn7 <br /> T 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 rh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C '_ <br /> WILL BE RETURNED. T <br /> n_r c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) "1 0 <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 cN* uo <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) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) n; <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK N <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 CIS g <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 4- <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. in <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 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> r � � <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER �r <br /> SETBACK AREA. T <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> ^gg n o c o y ? �f <br /> 7, 3 n n 333 - _ � <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 F a R.A.a. .�' r <br /> E <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all ii. 9 J <br /> inform .atlon contalned In this application(Including any accompanying schedule)and I further declare that I recognize that this > = '� N . <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I � � � .c w`.°y �� -o <br /> further accept all liability that may be a result of the County of Burnett retying on this Information I am providing in this '�8 c <br /> application. [agree to permit Is charged with administrating county ordinances or other authorized person to have S <br /> access to thei= remiss an t nabla time for the purpose of Inspection. ii w a D <br /> OWNER'S SIGNATOR " 3 <br /> (date) cc 00 <br /> a a <br /> ZONING ADMINISTRATOR _ af <br /> t`t <br /> m <br /> TOWNSHIP PERMITS MAY BE REQUIRED a <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ti o: �^ <br /> f <br />