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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a 3 ? <br /> APPLICATION FOR LAND USE PERMITS = = W <br /> OWNER :S`C' n j: ��C M �� TELEPHONE ( S/ .� yy/1i _ c <br /> U <br /> MAILING ADDRESS qq 6 i <br /> I l 5 /71vl G /a Qr,Q 4 V!, cut >,/12 o I 2 <br /> PROPERTY ADDRESS f v <br /> V � d0 <br /> LEGAL DESCRIPTION �} I CSM V , oC I j� , � -1� �- <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK GARAGE/ACCESSORY STRUCTURE ❑ I y: <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> a <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ 7 ^s <br /> b � <br /> STRUCTURE/ADDITION USE: z <br /> (Home/Cabin Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> n <br /> T <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Y:X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS c <br /> WILL BE RETURNED. r <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) r 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 <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) BUILDINGS) 0 7 <br /> TO CENTERLINE OF ROAD,(C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK m W <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. <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 o V <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. — I <br /> THIS PERMIT IS SUB3ECT TO ALL CONDITIONS LISTED BELOW: I \ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. J`n' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. g Z ICn <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 /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6, <br /> 7. ^gam > nnnn » y <br /> n <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my m' <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 contalned 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 > <br /> further accept all liability that may be a result of the County of Burnett relying on this <br /> Information I am providing In this <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have c 8$ $ g <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. ra „ <br /> 3 A > � $ o $$ 'D'i <br /> OWNER'S SIGNATURE E-� S- �7 D Sr 3 ee > a .. <br /> (date) o H �o a3 �5 =1 Z <br /> ILI <br /> ZONING ADMINISTRATOR I!11 ` L�.n •<, v � v 6 ', ; c c s7 <br /> J � <br /> TOWNSHIP PERMITS MAY BE REQUIRED a <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE w <br /> � r8iA o <br /> o � oo <br />