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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator w -0o 01 <br /> Z <br /> APPLICATION FOR LAND USE PERMITS � 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work � y <br /> described and located as shown herein. The undersigned agrees that all work shall be done inaccor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other = o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. aT <br /> B <br /> OWNER "Rb �e T TELEPHONE U ZS p o <br /> HOME ADDRESS <br /> 72_� eheL <br /> EMERGENCY/FIRE NUMBER 792 ROAD NAME <br /> ' <br /> LEGAL DESCRIPTION(see tax receipt)44 <br /> CONTRACTOR HHHHP'"' /4= <br /> o ci <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTUR ADDITION 0 �J <br /> y ..r <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION Z o <br /> o <br /> STRUCTURE/ADDITION USE: � <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> r <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) p 3 <br /> T9 m <br /> T o a <br /> 1. All required dimensions or distances to be shown or drawn to scale. m s' <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB) and indicate N <br /> North (N). y (� <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) building(s)to centerline of m i <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM) of lake, stream or river. <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildings, <br /> uildi gs, Q <br /> roads, lake, lot lines. (i <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 plans muE t be on <br /> signed and dated by the owner. ) U) <br /> C' 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION E- C <br /> FORE A PERMIT CAN BE ISSUED. a <br /> N <br /> o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. (` <br /> CONDITIONS OF PERMIT: x <br /> O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMI T <br /> 0 <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELI 4E. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ? <br /> PERMITTED. ( D <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF HE m <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. erste <br /> 5. <br /> 6. <br /> 7. <br /> Mm< N<: mCyO oO�n3 <br /> ' � N <br /> Zo ' = rn <br /> 8. ' � 2 i m <br /> S ? C <br /> m : M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the beat of my i i m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and acc iracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I re cognize " 0o m00 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whott or to is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this informal on I am n o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances r other <br /> authorized person to have access to the above described pr Ises at any reasonable time for the purpose of Insj iection. <br /> S •_/ _ L M <br /> SIGN HERE <br /> Ian ure of owner or b I contractor) (date) P [ <br /> o : <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PE TS MAY BE REQUIRED0 <br /> 0000 D o m <br /> C,o 0000 00tH <br />