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(PAY I <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator w ; -- o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work <br /> described and located as shown herein. The undersigned agrees that all work shall be done in accor- <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. y m <br /> / O <br /> OWNER c TELEPHONE ;'i' <br /> M <br /> HOME ADDRESS 17 �, �)f fv) <br /> EMERGENCY/FIRE NUMBER ROAD NAME ) <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR A_e <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING_ GARAGE/ACCESSORY STRUCTURE ADDITION 0rCT <br /> �. <br /> N r <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> - <br /> Z o <br /> STRUCTURE/ADDITION USE: <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. m <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> O 3 <br /> m a rn <br /> 1. All required dimensions or distances to be shown or drawn to scale. p o a <br /> 2. Show the location and size of all existing buildings(EB) and all new buildings (NB)and indicate rn N: <br /> North (N). C <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. 0 <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 <br /> signed and dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 2. <br /> CONDITIONS OF PERMIT: v <br /> f/1 <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 Z <br /> PERMITTED. :b <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE <br /> OHWM OF <br /> LAFKvES, Y PONDS,tvRIVER UNrLcEsSaS SPCIFICALLY PERMITTED.II <br /> rw `I o D ri ..Q Q C.,, . & , �,- <br /> I�u.) <br /> 6. <br /> {( 1:7I L( f t> 6e re^outc4 Vi-or- "cvo 6)•-d l„4) 14t y h L.14'�s MA4, <br /> rnrn � rnr yaCD Mm <br /> `200 ��0 <br /> s. Sc�,uf��y P�irmi-L ICI Z � _ Ta <br /> P <br /> N: 6 C <br /> M <br /> n : <br /> N (D <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my w m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of c, w O <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o o <br /> o , o : <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- o : o : <br /> rmation I am n o <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this info <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other w <br /> authorized person to have access to the above scribed premises at any reasonable time for the purpose of inspection. m `: m O <br /> w <br /> SIGN HEREi ti A <br /> (s1 t e owner b I contractor) = <br /> o <br /> ZONING ADMINISTRATOR q <br /> I Y fo(ft(w N N 1 U <br /> TOWNSHIP PERMITS MAYBE REQUIRED t . 1C7V !r o y� Nn cn o <br /> 0000000 <br /> 0000000 <br />