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07L.2 e " /- l <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o 0 <br /> APPLICATION FOR LAND USE PERMITS d 3. <br /> TO THE 20NING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work <br /> z s <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- 3 <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 <br /> OWNER r (� TELEPHONE <br /> K6u) c.� L l. 6r 0, c` L ?1'2 y9cs� <br /> HOME ADDRESSi <br /> Q,S`-lY "7�% ST � �F,`S�9r;,o �� �TY� Ps/I' �I <br /> EMERGENCY/FIRE NUMBER ROAD NAM <br /> E_T_ i tlF i4Cc f.�� Ryr}t'J <br /> LEGAL DESCRIPTION(see tax receipt) ,i_J�p ['� r� 310- RI y 0 <br /> CONTRACTOR �'ml .11 G ` �J G,�-- �'�p�-�. p n I <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION 0 <br /> y ^ <br /> O <br /> SANITARY PRIVY--,,?CFILLING/GRADING CAMPING UNIT SUBDIVISION <br /> .0 0 <br /> L n _ m <br /> STRUCTURE/ADDITION USE: STO R ACof/ RLL" l._o rj rW <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> r <br /> o_ <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> x <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 <br /> T c(�7 <br /> T Z <br /> 1. All required dimensions or distances to be shown or drawn to scale. m P <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB)and indicate <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. 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 ,J I <br /> signed and dated by the owner. G <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. t/:tt1TiF FHACo5 pN 'TREES - <br /> Cpho-NO FROZEN - QOttit-p NCT STR)(& 0 (JU <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY I D <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE <br /> OHWM OMINDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> 6. <br /> W ; i gfa'0F � M <br /> a ' m <br /> 7. m M 9: m c y o � 3 <br /> Z 9 <br /> 8. P m <br /> of <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my m <br /> �� �: <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o m u, : D <br /> PP (including Yaccompanying ) g : o m o <br /> all information contained In this application meludin an schedule and I further declare that I reco nize m b , <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- $ '• <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 n o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or othe 3 ig <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. qm y <br /> R N <br /> H <br /> SIGN HERE <br /> (signature of owner or II g co cto (tl e) o <br /> i o i i <br /> ZONING ADMINISTRATOR <br /> N N O i N N N t n m <br /> TOWNSHIP PERMITS MAY BE REQUIRED O v v O v u u o <br /> 000000 $0 lml) <br /> � x <br />