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C O O <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g � <br /> APPLICATION FOR LAND USE PERMITS N <br /> II CC pr II / <br /> QY1�T LJ U2 F��e C T 1 lA V, TELEPHONE �O� ' lo� Ll <br /> 1ra '^^ <br /> MAILING ADDRESS i ( � �( 1 /^ C Q Aairces `f `` s o '/ ` / <br /> ��/LAw <br /> PROPERTY ADDRESS d `lr 8 (,i <br /> LEGAL DESCRIPTION C ,q q T?) Lv-- a C S •� ^ p �� _ o °� �1 <br /> TYPE OF PERMTr(5): SINGLED-FAMILY DWELLING 11 ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ S <br /> STRUCTURE/ADDITION USE: 'c z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. c <br /> a C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) a[ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. c °i <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW M uroa <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, EI <br /> AND INDICATE NORTH (N). N O 11 z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S) TO ALL LOT LINES, (B) BUILDING(S) � I ° <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S) TO THE ORDINARY HIGH WATER MARK 5. C o <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. p W <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 o CT,� <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. f„ <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. �y <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. Z > 0 0 o n c o -0 <br /> 3 <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my o <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 °. D D W N <br /> information I am providing will be relled upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have n.2 <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. a <br /> OWNER'S SIGNATURE �t'�SLSI ¢'�G.X-1�-iy�C�/ (date) a B <br /> ZONING ADMINISTRATOR a✓)'� �f`7 � � w' : 8 n rz1 <br /> TOWNSHIP PERMITS MAY BE REQUIRED a �` <br /> THIS PERMIT SHALL EXPIRE ONE YE R FROM DATE OF ISSUANCE =N <br /> hG✓mi� � �� � aV>�itlafDj-kr-eft✓ lu �-l� fl� � � 00000 <br />