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S O <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS - <br /> OWNER TELEPHONE <br /> O <br /> MAILING ADDRESS rj f7 q o/2 <br /> �1 � <br /> PROPERTY ADDRESS dJ <br /> 5 13 <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMTr(S): SINGLE-FAMILY ELLING O' ADDITION 0 DECK❑`<-GA✓RAAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE 0 59.692(1V)GAZEBO O STAIRS O FILLING/GRADING O CAMPING UNIT <br /> v <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMM RCIAL ACCESSORY STRUCTURED c " <br /> STRUCTURE/ADDITION USE: (-'J. <br /> (Home/Ca in; Cd0hmercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: SP n <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yx X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS G o` <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n n <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, p <br /> AND INDICATE NORTH (N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK a, <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. O <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF),AND ALL DISTANCES �l <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. ti i <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 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. j^ <br /> NOTE: BUILDING/STRUCfURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. (p <br /> THIS PERMIT IS SUB7ECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Z I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 8 <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 G <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 /> yannn aoro <br /> 7 " � "Rn 3o on 3 �n� � <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 0."n B. ?w <br /> knowledge and belief it Is true,correct and complete. 1 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 <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I m �"^, <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 c w N <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have n 0 8 8 <br /> access to the above-described premises at any reasonable time for the purpose of I pection. m ,o w N c y <br /> `x/ <br /> OWNER'S SIGNATUR ' Z / "" —0 by y L <br /> (date) o r Ag°, a Z <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE "HI' " <br /> �� 8P <br />