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N 9 z <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator < �J <br /> APPLICATION FOR LAND USE PERMITS ry <br /> 6 <br /> OWNER c) TELEPHONE �(" !�" <br /> MAILING ADDRESS <br /> V\6 <br /> � 1 <br /> PROPERTY ADDRESS <br /> d 1) < <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING D ADDITIONEI DECK D GARAGE/ACCESSORY STRUCTURE 5 ¢ <br /> BUNKHOUSE D 59.692(1V)GAZEBO D STAIRS O FILLING/GRADING D CAMPING UNIT O <br /> COMMERCIAL BUILDING D COMMERCIAL ADDITION D COMMERCIAL ACCESSORY STRUCTURED <br /> STRUCTURE/ADDITION USE: GQ o O <br /> t,7 r QED -QYJ —. .A 4e, L n 1 0 <br /> ome in; ommerci usiness; a room; eC ;e c. <br /> N <br /> BUILDING CONTRACTOR: Qf ei ►� yJ (� f� r•J y <br /> 3 )1 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS _ h <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) to O <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 o <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH(N). N <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) o <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <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. = y <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 F <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 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: v ` <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n 2 <br /> 01) <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. '7c <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. <br /> S l p coov c�b M <br /> fD a <br /> F <br /> ' 3 3 <br /> a <br /> I declare that this application(including any aompanying schedule)has been examined by me and to the best of my d o ,3 P E <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all n m d <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 c a <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this 'moo - <br /> ` <br /> application. I agree to permit county officials charged with administrating county ordinances or other author ed person t n 5 <br /> have access to the above-described premises at any r sanabk:time for hepurpose of inspection. <br /> ---y <br /> OWNER'S SIGNATURE `i / g�7 I I 3 '+7 > N g 8 c S y <br /> I�y� , date <br /> ZONING ADMINISTRATOR ll/V / <br /> .... (date)) <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE 8 <br />