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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator co - E o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work z� N <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- <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. H m <br /> OWNERLIPS' TELEPHONE / 5- 3 y 3y% o v <br /> HOME /40, 1 7' C,ADDRESS / `, �! L S'd /)�( S-t4 7 2 0 <br /> I <br /> /li�rl t/> wC sr G/ilii /` <br /> EMErtuon��N01-RRE r c A ROAD NAME <br /> ilitTS /:L.4 b�' >r � J�E11TSov (7o //iJ <br /> LEGAL DESCRIPTION(see tax receipt) <br /> w� sr <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION 0 <br /> y O <br /> O <br /> SANITARY PRIVY—_FILLING/GRADING CAMPING UNIT SUBDIVISION v <br /> o v Vv <br /> STRUCTUREIADDITION 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. nl <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) p B <br /> 'n P to <br /> T O i£ <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 h: <br /> North (N). ori i ' <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) building(s)to centerline of m <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. x <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildings, <br /> 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 plans must be r <br /> signed and dated by the owner. w <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: v <br /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT s <br /> ISSUANCE. r� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �V <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY n <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> f <br /> 6. <br /> mrn '9 fn D D <br /> W o,a M. 0 8 e m <br /> 7. <br /> N 0, .0 on 3 <br /> 9 N O <br /> = F I -!rn i <br /> 8. o A <br /> o : m C <br /> m � C <br /> I declare that this application (including an accompanyingschedule has been examined me and to the best of m ` . I � [ M <br /> PP ( g Y ) by Y <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of y O <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize o o <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> o : o : <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Information I am <br /> o: D <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. m ? i i <br /> SIGN HERE <br /> N ; <br /> (signature of owner or building contractor) (date) o i <br /> o ; <br /> ZONING ADMINISTRATOR �/Yl �(�I/�lo�'fl � E(q i{q '• <br /> N N t n N N N N m <br /> TOWNSHIP PERMITS MAY BE REQUIRED 911 n n o m <br /> 00000oo <br /> 00000000 Vl <br />