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C p <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS N N <br /> OWNER � <br /> TELEPHONE <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS = , <br /> 7 Loop✓ Gly �0�9� o <br /> LEGAL DESCRIPTION c O <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ rn <br /> 4 =. <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRSXI�FILLING/GRADING ❑ CAMPING UNIT ❑ W <br /> v <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADD/II--TION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: .Ti')�mtrL✓1Q �T(til✓S c �- <br /> (Home/Cab ; Commercial Business; Bedroom; Deck; etc.) <br /> Qx <br /> BUILDING CONTRACTOR: (� <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS � o <br /> U <br /> WILL BE RETURNED. J <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 46c- .iu m 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. r[ <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW V cn w 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, J p <br /> AND INDICATE NORTH (N). N Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) o jU <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK SU J O <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. I p ti <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES 9J N <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. ,�i <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 6 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE a '+- <br /> r <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. ) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: G U <br /> F <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ) n z d <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 0 <br /> SETBACK AREA. N j� <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. V <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. ao r o C� > b <br /> 1 declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 0,°2 _ n <br /> knowledge and belief It Is true,correct and complete. I admowledge that I am responsible for the detail and accuracy of all o, m m d L. c y <br /> Information contained In this application(Including any accompanying schedule)and I further declare that 1 recognize that this Y <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I '� $ = .o <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 <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. <br /> mq ? Dog000 > <br /> OWNER'S SIGNATURE <br /> \'� (date) <br /> I11� � <br /> �" I + Ran(oa6N Sa mmy <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0' <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE `- <br /> PPtrn1� � <br />