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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o o <br /> APPLICATION FOR LAND USE PERMITS 3 9J <br /> `" o I /1 <br /> N v 1 <br /> OWNER TELEPHONE 9(5_32-951'e) I o p <br /> HOME ADDRESS ��cj Co Lytle eel <br /> 0CD <br /> EMERGENCY/FIRE NUMBER '08 fS1 ROAD NAME Co <br /> LEGAL DESCRIPTION (see tax receipt) Ov 1fir, c Q 3 rl tJ <br /> DWELLING/BUILDING -GARAGE/ACCESSORY STRUCTURE ® ADDITION PRIVY ( 0 <br /> TYPE OF PERMIT(S): G <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE:__C I 1460`e �V SLdAF:� o <br /> (Home/Cabin; CommercialBusiness; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: I �2 ^� <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> T <br /> T -a Z �\ <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(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ° <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS,ROADS, LAKE, LOT LINES. J Q <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I ry <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 1 <br /> �O 0 - <br /> MUST BE SIGNED AND DATED BY THE OWNER. F ` <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN = o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o I <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. / <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. W �l <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. �f <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> W 0 D � m <br /> CD <br /> n GOC m r° n d <br /> 6. �7 � I�j OrEffn � �� mO _ <br /> 7. O T <br /> - Cn : m <br /> I declare that this application (including any accompanying schedule) ha an examined by me and to th st of my 0 c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I respo �Qr tNel and c uracy of a T <br /> all information contained in this application(including any accompanying ule)a11d1 fu leer declare tha ecognize DCD 0 <br /> that this information I am providing will be relied upon by the County of B Wisconsin in determinin her to is- <br /> sue a permit. I further accept all liability which may be a result of the County o � [se'�nC@W� rmation I am l/� ° <br /> providing in this application. I agree to permit county officials charged with a mmisteeyy ordinances or otherCD <br /> 1: <br /> authorized person to have access to the above described premises at any reasonable tir gmrpose of inspection. -n <br /> CD <br /> m : <br /> l l <br /> SIGN HERE 01 <br /> r (signa o owner or 'Id' g contractor) (date) <br /> ZONING ADMINISTRATOR ✓ <br /> TOWNSHIP PERMITS MAY BE REQUIRED g <br />