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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m m -- 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> a s <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for theZ5 work � y � <br /> described and located as shown herein. The undersigned agrees that all work shall be done in ccor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with al other 3 <br /> 0 <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y m <br /> ys ag 3 <br /> OWNER TELEPHONE 7/5 f ^p <br /> HOME ADDRESS 105-9 J r b le me MNGCJ Me-Ode N ,/ //(bl 5 5W v /�_._ <br /> EMERGENCY/FIRE NUMBER <br /> -117,9 �r e . OAD NAM -5—!l 93 <br /> 301-3 ,73/ t%�9 'f7 z /z $a 6 T n RlSW C1Q <br /> LEGAL DESCRIPTION(see tax reoeipt),V—'At <br /> CONTRACTOR <br /> G) W <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE--ADDITION--Z0 <br /> o _ <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION— <br /> Z <br /> 0 <br /> STRUCTURE/ADDITION USE: t I Uln�Are4 .; Y X3U <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 C R <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> X u <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 8 <br /> r p in <br /> 1. All required dimensions or distances to be shown or drawn to scale. o i <br /> 2. Show the location and size of all existing buildings(EB)and all new buildings (NB) and indicate in N: <br /> North (N). C I 0 <br /> 3. Show dimensions in feet of the following: a building(s) O building(s) m C� <br /> ( ) ng(s) to all lot lines, b buildin s to centerlin of (J <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or ri r. $lJ <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildi gs, $v 1 <br /> roads, lake, lot lines. !S <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. C <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans mus be (, i <br /> signed and dated by the owner. Y <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION B - <br /> FORE A PERMIT CAN BE ISSUED. <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. e <br /> CONDITIONS OF PERMIT: o <br /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMI <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF I HE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> 6. �5—csi-n'4::a ry A <br /> 7. ✓�{� � / 63207 yc � N� n > ° m <br /> 8. 6f(/.(��) Ila - Q- ' 7� prod a.s �.a m $a m_ <br /> Sree/�/ v0/ i <br /> O - <br /> n [ � 2 m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the besi of my m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accu acy of <br /> all information contained In this application(including any accompanying schedule)and I further declare that I ree gnize : o o <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whethe to Is- $ o <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett retying on this Informati n I am n ° <br /> providing in this application. I agree to permit county officials charged with administering county ordinances o other 3 x <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Insp4 ction. <br /> SIGN HERE <br /> (signature own r orb ding n tor) ? ; <br /> r $ [ <br /> ZONING ADMINISTRATOR <br /> z. <br /> 'AMT NSHIP PERMITS MAY BE REQUIRED z 9 0 0 0 0 ' o o m <br /> X8' 000 0 opl <br />