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(!>) <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 'Office of Zoning Administrator ,� 0 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work y iS <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 - o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. H m <br /> OWNERRATE EPHONE a v n <br /> / y <br /> !.(/ L sP <br /> HOME ADDRESS AWd <br /> CGp-/ / �L ���rlTL <br /> EMERGENCY/FIRE NUMBER ROAD NAME( C ds4�/ /_ s r1495�U �f <br /> 04 <br /> LEGAL DESCRIPTION(see tax receipt) C . �, .S� fe <br /> CONTRACTOR <br /> F o (�- <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE—>—(' ADDITION •�-' <br /> N m <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: A17191,41. (>C/MG bl,4 O S <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) /1 \ <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE C R <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In _ <br /> O — <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> 'n P N <br /> O <br /> 4 <br /> 1. All required dimensions or distances to be shown or drawn to scale. n � <br /> 2. Show the location and size of all existing buildings(EB) and all new buildings(NB)and indicate m <br /> North (N). C <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerlin m of P <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. a <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildhigs, <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 mus be , x <br /> signed and dated by the owner. �� � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE <br /> -FORE A PERMIT CAN BE ISSUED. c, , <br /> N JO�U <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. J <br /> CONDITIONS OF PERMIT: o <br /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT2 (}I <br /> ISSUANCE. j <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELI E. _ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY z D <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF HE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> 6. <br /> oc �Nlu DDoy <br /> 7. p $� �'-. a8m m <br /> o m <br /> N 0 ; : !1 -1 <br /> Z f TIN <br /> 8. o - <br /> Vic : m <br /> o ` aSE C_ <br /> I declare that this application (including an accompanyingschedule has been examined me and to the boil of m ` ' O' ` XI <br /> PP ( 9 Y ) by Y <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and aeeu ae of ` m m <br /> 9 P 9 P Y ' fn m rAn <br /> all Information contained in this application(including an accompanyingschedule and I further declare that I re E oto o <br /> PP ( 9 Y 1 gnlze - m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining wheth to is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this infonnati n I am O: o : <br /> providing In this application. I agree to permit county officials charged with administering county ordinances other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of H E <br /> ,t <br /> SIGN HERE <br /> Is a o s r building eontracto t V (data) 'i o <br /> ZONING ADMINISTRATOR -2 / MAY 0 g <br /> fyi i i y <br /> i� I --�- ' � tNiio NNNom <br /> TOWNSHIP PERMITS MAY BE REQUIRED m <br /> —" o000000grn <br />