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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator - <br /> APPLICATION FOR LAND USE PERMITS = <br /> V✓NI R 9 <br /> TELEPHONE <br /> MAIL TNG ADDRESS <br /> PROPERTYADDRESS — /--1 <br /> FGAL DES(:RIPTION } <br /> 07 <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING CI ADDITION;❑ DECK❑ GARAGE/ACCESSORY STRUCTUREfd _ <br /> BUNKHOUSE❑ 59.692(IVIGAZEBO❑ STAIRS❑ FILLING/GRADING❑ CAMPING UNIT[i j = <br /> COMMERCIAL BUILDING❑ /COMMERCIIAAYL ADDITION❑ COMMERCIALS A/[CESSORY STRUCTURC ❑ ' <br /> STRUCTURE/ADDITION USE __--6Al2 aL�n _ 3'l/� L�1i./ h E IJ <br /> (Home/Cabin;Commercial Business m; :Y- QI �-- --'---- 7 <br /> Deck;etc.) <br /> BUILDING CONTRACTOR: <br /> - O <br /> A PLOT PLAN MUST E PROVIDED ON AN 81h X11 SHEET OF PAPER. ANY I COMPLETE OR ILU UIT e 0 PLANS <br /> WILL BE RETURNED. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) - , `2_ <br /> 1. AL I.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, O rt 3 <br /> AND INDICATE NORTH(N). , <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) -z <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK Oi <br /> (OH WM)OF TAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. I Cp'9 <br /> 4, SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES N <br /> TO BUILDINGS,ROADS,LAKE,LOT LINES. c j i <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. J <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER, THE t�CONTRACTOR,ETC,. -I <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. I11 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN i�"\1 I <br /> NEEDED. N` <br /> THIS PERMIT 1S SUBIECT TO ALL CONDITIONS LISTED BELOW: -� <br /> )}V� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60A DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING L TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING ES INCLUDING ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. z <br /> 9. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. 6 <br /> 5, ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLYO <br /> (5 TO BE USED FOR`OMAN,He -;;>N.�O L � ROW x <br /> f. /l�� I� Un 11 ILc3 / 111 <br /> 3 3 <br /> I detlare Na[[his applkapon(Intludllq any ac:Iom anyllp stlledule)has been oamMed by me and to the beet or my <br /> j ' <br /> knowledge and belle!R Is true,correct and canpiete. I atlmowledge the(1 am responSlNe For the detail and aavnry a(ell <br /> Intormauon[antelned In this epplleatlon Untludhy any aceo,n"anyhV sdiMRle)am,I Nr Eedam that 1 <br /> . Information I em My1ding will be railed upan by the County at BumMt WLs o,tgn in datenn rcaue a j Net this <br /> /vrthn ecce"(all <br /> 11abinty Nat may be a,esuR or the eau,Ity or eunett N`v to Issue a permR. t <br /> e"plkaBon. t o reryap ty TMs IMplia oro I r a gl N la N5 w <br /> g,ee to permB county oNat an Bulged whh time <br /> for �Khlp county ardMances or other euthodxed"anon to have _ 3 <br /> access to the above-deaotbW et any rcesonaple three fOt Ne purpose ar I,tW ectim. <br /> 3 Y <br /> OWNER'S SIGNATURE �30 1.1 <br /> A <br /> �'�Ay' <br /> (date) <br /> LYS <br /> ZONING ADMINISTRATOR ? '. <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> D MOVE <br /> MAY 3 0 2012 <br /> BURNM COUNT, <br /> ZONING <br />