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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 ry <br /> a <br /> OWNE ) y\ U11 2K1 TELEPHONE <br /> O <br /> MAILING ADDRESS <br /> \- n <br /> PROPERTY ADDRESS,� <br /> � r <br /> o � <br /> LEGAL DESCRIPTION, 2 <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK O. GARAGE/ACCESSORY STRUCTURE v Q <br /> a <br /> BUNKHOUSE D 59.692(IV)GAZEBO O STAIRS❑ FILLING/GRADING EJCAMPING UNIT 11 <br /> o o <br /> COMMERCIAL BUILDING Ll COMMERCIAL ADDITION L1COM RCIAL ACCESSORY STRUCTURE ❑ <br /> I D <br /> STRUCTURE/ADDITION USE: /O D Sigfee , �U� -z:=.- /ao <br /> ome in;LOMmercial business; room; DeC ;e c. <br /> BUILDING CONTRACTOR: � 3 <br /> � o <br /> c <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLAIIS <br /> WILL BE RETURNED. <br /> n d <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) C <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 m o <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <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 1 <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. I y <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. E <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 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. ?CJ y <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN C� <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: �? <br /> i Z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. a <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. /r <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. SdV <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• an nn oa p '0 <br /> El El <br /> 7. z o c 3 E ° ° t. <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my m a y $ y <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all a n a T^ : Y <br /> information contained in this application(induding any accompanying schedule)and I further declare that I recognize that this " E <br /> Information I am providing will upon by the County of Burnett Wisconsin in determining whether to issue a permit. I ,��, n `' N _ o (%` <br /> further accept all liability tha ay be result nf t County of Burnett relying an this information I am providing in this g Eu a D0 o "" <br /> application. I agree to per county �cials ch rg wtth administrating county ordinances or other authorized person to have m w y a <br /> access to the above-d gybed premi at y r nable Ume for the purpose of inspection. g o <br /> OWNER'S SIGNATU S <br /> a mnp _ _ z <br /> m <br /> ZONING ADMINISTRATOR ^� - <br /> n <br /> w m o <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE d U U U <br /> 8 0 o G g <br />