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ok � , <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator (n 0 o 0 <br /> APF"LICATION FOR LAND USE PERMITS d 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for a 2 <br /> work <br /> described and located as shown herein. The undersigned agrees that all work shall be done th work 3 n <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other - <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. N m <br /> O <br /> OWNER la _ I•` 1 ( TELEPHONE o <br /> 2" w <br /> HOME ADDRESSAw. <br /> I\•A 0C�� `� /e n) 66) l <br /> EMERGENCY/FIRE NUMBER L- CRROAD NAME f LEGAL DESCRIPTION (see tax receipt) - <br /> Y, /o / <br /> CONTRACTOR <br /> 0 <br /> m G7 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION 2 <br /> o' ,�- <br /> N r <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT O <br /> SUBDIVISION 'o <br /> a <br /> 0 o <br /> f <br /> STRUCTURE/ADDITION USE: i I IF-Il l,_ . <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> r <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) A o <br /> O 3 <br /> 1. All required dimensions or distances to be shown or drawn to scale. n o a <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB)and indicate m y: <br /> North (N). C 0 <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerlin N <br /> of m ( C� <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. -C <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildings, -C- <br /> roads, lake, lot lines. so <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. I U1 <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans musl be <br /> signed and dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION B <br /> FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELIN E. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY z <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OFT E <br /> 5. OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 6. F <br /> rn fnvrn D D O <br /> m n� -fam ,: a <br /> mo Lai : -I <br /> 8. u f ' : TN: >, <br /> �3gi I m <br /> b i N a ' Q <br /> o : asi <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my I Lj m <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of k p <br /> all information contained in this application(including any accompanying schedule)and I further declare that I rec gnizeo o <br /> Q� o , o : <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this informationI am p <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. im I <br /> � N <br /> SIGN HERE w ' <br /> En <br /> (signature of owner or building contractor) (date) c, : <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N <n N N N N m <br /> 000000 OO (n <br />