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1 <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER ✓eh 1111' .// H��/� �• J?-/„H TELEPHONE Cil. �� ���� _ �- <br /> MAILING ADDRESS ^ I // � / <br /> PROPERTY ADDRESS <br /> 30.;17 <br /> / // 1.I" <br /> �'cyCOa� j= <br /> LEGAL DESCRIPTION ej et /)e lX. /Hr <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/A ESSORY STRUCT E <br /> BUNKHOUSE ❑ 59.692(IV)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ � <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURED <br /> 1.rbb I�' <br /> STRUCTURE/ADDITION USE: <br /> z <br /> (Home/(-abin Commercial Business; Bedroom; Deck; etc.) <br /> ice} <br /> BUILDING CONTRACTOR: <br /> a <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 r�X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O I .�-) <br /> WILL BE RETURNED. � i <br /> n .p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) � �- <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 cyi <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). W <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 'e'J <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 g <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <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, <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: <br /> I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ,-, Z <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. a <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER r it <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> OT TO BE USED FOR HUMAN HABITATION. <br /> 6. be yarbm f i allt/.tL/n e//��4/ . <br /> �. <br /> 2 353 rt c n MI declare that this application(including any accompanying schedule)has been examined by me and to the best of my e J 3 ” g 5 m' <br /> knowledge and belief It is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of all d ' f s <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this --q <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I > <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this c ,'� m , <br /> application. I agree to permit coun ofFlclals char with adminls[ratlng county ordinances or other authorized person to have C c o <br /> access to the above-descil se at any re nable time for the purpose of Inspection. 5 o o . <br /> a <br /> OWNER'S SIGNATU y � <br /> a d <br /> ZONING ADMINISTRATOR 1 2 <br /> o r a <br /> WSHIP PERMIT MAY E REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF WAARW COUNTY = <br /> ZONING � �� � � <br />