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z <br /> Burnett County 7410 County Road K,No.102, Siren,WI S4872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER C,�-,4re•I A, U-.rv� TELEPHONE S - C6�2..�" g C '� o <br /> m <br /> fv' <br /> MAILING ADDRESS <br /> CLQ s � lLs \ e i rS- �S �l <br /> PROPERTY ADDRESS o I <br /> LEGALD CRI ON \ <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING❑ ADDITION ❑ DECKA GARAGF(ACCESSORY STRUCTURE❑ A' f <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO❑ STAIRS O FILLING/GRADING❑ CAMPING UNIT❑ <br /> z <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ -C ° <br /> c deck neat- e� iw i <br /> STRUCIURE/ADDIIIONUSE: j <br /> orae n; mmeroa sin room; <br /> BUILDING CONTRACTOR: <br /> <c <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLAITS <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) M <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. y °o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW - E. n <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, aE. <br /> AND INDICATE NORTH(N). ` O c <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 p <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 S2J <br /> TO BUILDINGS,ROADS,LAKE,LOT LINES. y <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. G <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. <br /> H <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEPI <br /> NEEDED.. I r <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ` a <br /> n <br /> H 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. <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 /> N TO BE USED FOR.tiLIMAN HABITATION. <br /> 6. 1 ^ ;V annnna 0 - <br /> 7. Rnn33° O2BE � � <br /> 9 <br /> I declare that this application(including an accompanying u <br /> pp ( 9 Y ponying schedule)has been examined e f r t and t the best of my �' a w E $ i <br /> knowledge and belie!R is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all $ o,ii c m ^' <br /> Information contained In this application(including any accompanying schedule)and I further declare that I recognize that this <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I m E. N <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this g <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have m. <br /> access to the above-describ1pisey sonable time for the purpose of inspection. ` ! 0OWNER'S SIGNATURE J y J 1 ij m c(date)ZONING ADMINISTRATCl <br /> To <br /> PERM S MAY BE REQUIRED "R <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />