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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a ° <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER L%rTELEPHONE O Cx <br /> �I G <br /> MAILING ADDRESS . -Ll ` i r� �t /:1�. j l J iv e i-) r) LE , <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION ) �- /) I L) a F� ]cam r la^ <br /> TYPE OF PERMTr(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ U o ✓' <br /> STRUCTURE/ADDITION USE: <br /> o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> p <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN B Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C c <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW m v 3 <br /> BUILDINGS/STRUCTURES (NE), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, R <br /> AND INDICATE NORTH (N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK w <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 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 2 w <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 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. k) n <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN ...i �- <br /> NEEDED. <br /> C� n <br /> r <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ri Ui <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Z S, <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ` iN <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. i � � o 00a0 [ros1 <br /> � Yc333go: � 'A <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 0 ,� R ? 5 <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 v a n d a N <br /> information I am providing will be relied upon by the County of Isconsin In determining whether to Issue a permit. [ .`= <br /> further accept all liability that may be a result of th Bumett re Ing on this Information I am providing in this c y w ti T'`A N 'd <br /> application. I agree to permit county officials c ed Ith a Inistrating unty ordinances or other authorized person to have <br /> access to the above-described premises at reason ble ti e for the p rpose of Inspection. m a w N W f1 <br /> C, R o r"1j'D D O p O O y <br /> OWNER'S SIGNATU a =' mnpym0 <br /> (date) $ a> > tl <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ti o N N N o <br /> lGvtSG/� /i� � ( J� 00000 <br /> 4- le1_4ell piCe �ai�� <br />