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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator 0 o <br /> APPLICATION FOR LAND USE PERMITS m 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work Q <br /> described and located as shown herein. The undersigned agree's that all work shall be done in accor- SR C <br /> 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. w <br /> OWNER E Ie R ANC C 0 k1 i9C lr,£ TELEPHONE -71j- J,gy 3( CD <br /> S9 <br /> mR!`!Nc no Q � 2 W <br /> o 134 02cfSc / r"JOUY ;? <br /> HOME ADDRESSV ' <br /> /4Q11rC ,, �q rrj? £./ecce LQkf k.egel1 © pr„(,u" W/ S Y83 O �J <br /> EMERGENCY/FIRE NUMBER2 ROAD NAME ��(e [ 4 Qo A <br /> LEGAL DESCRIPTION(see tax receipt) S 3y /r Y/ /je c S w Sr, ,r s ro <br /> k c-c- Cn.o S S L SR <br /> CONTRACTOR CaocS �2�-c�te.� SfCc.a/ to F601C <br /> G) <br /> cp 2 <br /> TYPE OF PERMIT(S): DWELLING/BUILDINGGARAGE/ACCESSORY STRUCTURE ADDITION 'c o <br /> y O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> v <br /> m <br /> STRUCTURE/ADDITION USE: fr-00.r1 -f FA-Ml /7 Coot" %Scw/N 6 A-u o <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) <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. T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> O 3 <br /> T ? fn <br /> 1. All required dimensions or distances to be shown or drawn to scale. n o S <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB)and indicate m y: <br /> North (N). N <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. �` Z <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildings, W Z <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 d <br /> signed and dated by the owner. <br /> Cn8 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. <br /> N <br /> O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: v <br /> y <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 ? <br /> PERMITTED. :b <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE <br /> OHWM OF LAKES, PONDS, RIVER UNLE S SPECIFICALLY PERMITTED. <br /> 5. <br /> 111 gS,I.�si�2e be / faBll <br /> 6. I'll C71.1✓Y�l.(-1.� L4 ��' ri n��o 5Prn� .1� Sri J'rrL.1 lS <br /> rnrnvrn pDoy <br /> 7. s o, QM. WK � f m <br /> m a 1� n CD <br /> H O O fa 3 <br /> 8. z FT� : M <br /> o es • _ Cn: m <br /> 64 m <br /> i of aa i C <br /> R `,° <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the beat of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> �i <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o o <br /> , o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- i o , o <br /> 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 0: <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other w <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. CD <br /> n ? H <br /> SIGN HERE / /`� 3�x 6[cr 7 « <br /> ( n uro of owner r Ilding contractor) RI I <br /> ZONING ADMINISTRATOR _ I I 1.11_U — <br /> �y <br /> iy ; l ffqq��yy <br /> � ., jij -+N(A 01 <br /> 0 NNNN m <br /> TOWNSHIP PERMITS MAY BE REQUIRED : I MAR Z T M io o c o g o0om <br /> ; '' 0000 <br />