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5-1 GIn-W <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator co m 0 0 <br /> APPLICATION FOR LAND USE PERMITS d 3. <br /> z <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 actor- 3 n <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 /> OWNER TELEPHONE 6 Z 6'l7- r( b 7 _° v <br /> HOME ADDRESS ,2 <br /> / ±3q /7w L,LLs /dK Jt• rC hILI 1 171 JV Z5 s )1) <br /> S <br /> EMERGENCY/FIRE NUMBER aQ34y ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR \ l� <br /> 0 <br /> m c� <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE X ADDITION 5' .�.- <br /> N Q <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> p <br /> STRUCTURE/ADDITION USE: Shhe I Ptepp— <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. r <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) p <br /> O 3 <br /> T ? m <br /> 1. All required dimensions or distances to be shown or drawn to scale. o g <br /> 2. Show the location and size of all existing buildings(EB)and all new buildings(NB) and indicate m <br /> North (N). <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. <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 <br /> signed and dated by the owner. W u) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- a <br /> FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> N <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 l <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 /> NU1V U) r > D <br /> 7. M o, Q ' 0. � 3 $ m <br /> 8. Z Fes : TN 1 <br /> o In <br /> N N 7f <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the bestof my ' m <br /> ii; <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of ? �, N O <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 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- 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 n p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 x <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. <br /> m <br /> /J Is N <br /> SIGN HERE <br /> (signature of owner or bu ding contractor) (date) 0 <br /> ZONING ADMINISTRATORtE <br /> o <br /> o to WT—n 6-0: <br /> N N (!i N FN N f l i m <br /> TOWNSHIP PERMITS MAY BE REQUIRED c u, u o v, p o o m <br /> 0 0 0 0 0 0 0 0 N <br />