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z <br /> � 3 0 <br /> a <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator - <br /> APPLICATION FOR LAND USE PERMITS <br /> a <br /> A <br /> OWNER r 1 / TELEPHONE <br /> 14011 <br /> MAILING ADD 553W d <br /> PROPERTY ADDRESS 0 -d <br /> C/ {YY�V <br /> r <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ElADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTU :. <br /> BUNKHOUSE ❑ 59.692(1V)GAZEZE BO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING 11 COMMERCIAL <br /> M'' LlMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE <br /> COa <br /> `� — Z <br /> STRUCTURE/ADDITION USE: � <br /> �J(Hom bin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C <br /> �n <br /> WILL BE RETURNED. n c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m �% <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, f1 a <br /> AND INDICATE NORTH (N). p v T Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(8)BUILDINGS) �1, 5 ° <br /> TO CENTERLINE OF ROAD,(C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 9 b <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. <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. GVOJ _ <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. n , <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE JIB/ <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 / I� <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r- <br /> 1. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. j 'p <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r ` ' <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER IJJ I <br /> SETBACK AREA. �}�1 <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. F <br /> 6. <br /> 7. 3 3 3 lr a r�r1 <br /> El <br /> I declare that this application(including an accompanyingschedule has been examined b me and to the best of m N 2 0 o o <br /> PP C 9 Y ) Y Y 0 Ow <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 E. D m N <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I m c a w V .ad <br /> further accept all liability that may be a result of the Countyof Burnett relying on this information lam providing in this <br /> application. I agree topermit officials cha ad administrating county ordinances or other authorized person to m m o o0 o r <br /> have access to the above-desc d prem at na time for the purpose of insp ion. F ava > <br /> oo > <br /> o g y <br /> OWNER'S SIGNATURE / B <br /> (date) <br /> 1 ° G <br /> ZONING ADMINISTRATOR <br /> '� corn ts7 <br /> TOWNSHIP PERMITS MAY BE REQUIRED N <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE g <br /> 6_, <br /> to n 00000 <br />