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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator o <br /> APPLICATION FOR LAND USE PERMITS g C1� <br /> a <br /> nJ1 <br /> OWNER `�� {� / TELEPHONE <br /> MAILING ADDRESS <br /> 117 3a noh f fl ve <5{ PALA( 0 A) SS ll6 � <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION J L� <br /> DWELLING/BUILDING❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITIONX STAIRS ❑ or <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT❑ BUNKHOUSE ❑ 59.692(1V)GA 0 DE K ❑ Z <br /> Y <br /> STRUCTURE/ADDITION USE LGFlYt61)f LYy�Z�AZL-� �'IAGE GJm24I Z / <br /> (Home/Cabin; Comme ial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Va X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS n y J <br /> WILL BE RETURNED. O K <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. inn O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW y <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, Lw T <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) (' n <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 1 9 <br /> (OHWM)OF LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. N �, <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. oa Q <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. �? c <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE 4, <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. = 00 <br /> y r <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN n <br /> NEEDED. o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. C <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n <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 _I- <br /> SETBACK AREA. ly T <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY, C <br /> NOT TO BE USED FOR HUMAN HABITATION. E O <br /> 6. <br /> �F7 <br /> 7. <br /> Fee >N`Re`w <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge z w <br /> and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information e <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this information I 'E > <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept ail PI��(��^moi n <br /> liability that may be a result of the County of Burnett relying on this Information I am providing In this application. 1 agree to —I U <br /> permit county officials charged with administrating county ordinances or other authorized person m have access to the above- S n <br /> described promises at any reasonable time for the purpose of inspection. v,y <br /> SIGN HERE <br /> (sl re of owner or uildirq contractor) (date) H a U > ,� <br /> ZONING A INIST TOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE 8 o <br /> r� �m�� 'L.IP-+ 46(' (n6ii1Pd -to Tbr) /Jb�rs <br />