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� z <br /> � a <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator < (� <br /> ( APPLIC/ATION FOR LAND USE PERMITS = a � <br /> OWNERJ ]1 TELEPHONE 7/5— .7 3 7 7 d <br /> Q VVI% CZ Q t Tu n q <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS <br /> ° <br /> LEGAL DESCRIPTION <br /> w <br /> TYPE OF PERMI7(S): SINGLE-FAMILY DWELLING ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE 2 <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> o <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ _ n <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom; D k; tc.) rt7z�— C <br /> BUILDING CONTRACTOR: �� n <br /> A o <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/1 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS5 ~' <br /> WILL BE RETURNED. <br /> n a <br /> � o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) C p1 <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 <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, N E (Z!5 <br /> AND INDICATE NORTH(N). <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 CS <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. c <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. i <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN j <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: d w <br /> a <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. y zj <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 /> 7 s � > 0 0o >! dM <br /> R n y 3 3 3 � d_ <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 F <br /> knowledge and belief 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 ° > > E N : 9 <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 .oa.w'V 'b <br /> further accept all liability that may be a result of the Coun of Burnett relying on this information I am providing in this <br /> application. I agree to permit county officials cha ad w' admi ' tin or other authorized person to �° vD have access to the above-deu bed premises a y nabl fo T!inances <br /> f inspection. w w ,,, <br /> COVE <br /> OWNER'S SIGNATUR (date) y� n o :n 2+ <br /> o ; wQd = z <br /> ZONING ADMINISTRATOR AUG 282012 <br /> WNSHIP PERMITS MAY BE REQUIRED BURNETT COU <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ZONING <br /> u' EA : <br /> 69� N49696`+ O <br /> v tNi O O O O O <br />