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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator n o <br /> APPLICATION FOR LAND USE PERMITS g c1� <br /> OWNER /7/ L ,/ <br /> ^ A �(' �• lr TELEPHONE <br /> '� <br /> - C <br /> MAILING ADDRESS 1 G7 / J O("L. o <br /> PROPERTY ADDRESS / -4.5t,--s rn <br /> ��.-�- CFda,. Polke,.l,a.-nL-6-t � <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION STA RS Elo <br /> � <br /> FILLING/GRADING ❑ CAMPING UNIT❑ BUNKHOUSE ❑ 59.692(SV)GAZEBO ❑ DEC( ❑ C I <br /> O <br /> STRUCTURE/ADDITION USE: c c 3)— <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> _1 <br /> A PLOT PLAN MUST BE PROVIDED ON AN B V2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT I ILANS <br /> WILL BE RETURNED. p (! <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Inf O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW d I . <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) BUILDI G(S) n <br /> TO CENTERLINE OF ROAD,(C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK o <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. N <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTA qCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w' <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O <br /> ti. Q n <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC., THE cll <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> y <br /> NOTE: NEEDEDG/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Z C` <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE, n z <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 O <br /> SETBACK AREA. o <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE C NLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> R ^ �� R <br /> 7 . <br /> IT °weea <br /> 3 w <br /> I declare that this,co..application d coo(including arty accompanying schedule)has been examined by me and u the best 0f or know qe g z �„ <br /> and balk!K Is true,correct and complete. I acWawledge that I am responsible for the detail and accuracy of all Information S o <br /> contained In this application(including any accompanying schedule)and I further declare that I recognize that this Informabo I <br /> am providing will be relied upon by the Coun of Burnett Wlsconsin In determining whether to Issue a penult. I further accep all H='w <br /> liability that may be a result of the County of matt relying on thk Information I am providing In this application. I agree to o g t" <br /> penult county offl Is charged wl adm]nL unty ardlnances or other auttwrl person to have access to the above S <br /> described premises at any reaso le time ror urposs of Inspection. to v,s Ln y <br /> 5 law <br /> OWNER'S SIGNATURE A S i Z <br /> (date) y e$ g !s1 <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED G' <br /> j,y N <br /> G V M N Vh <br /> THIS PERMIT SHALL IXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> �m< M44erP1wed "P by Crcc� <br />