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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator d _ 0 0 <br /> APPLICATION FOR LAND USE PERMITS 6 3 = <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work � y <br /> described and located as shown herein. The undersigned agrees that all work shall be done in <br /> actor- 3 <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other - o r� <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> OWNER + /7�/1 Re JAA) TELEPHONE3 y �� Ll q e <br /> m <br /> �y S l 70 S V `° <br /> HOME ADDRESS mar <br /> EMERGENCY/FIRE NUMBER /nGj (,� ROAD NAME 5118q <br /> VISU( <br /> LEGAL DESCRIPTION(see tax receipt) p c z G a L) Lc,)j z <br /> 7.39 — / W <br /> CONTRACTORAL� G. �/J o <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> = r <br /> N ° <br /> O .. <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION <br /> � o v J <br /> STRUCTURE/ADDITION USE: �< �.LL��L 41 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> r <br /> ° <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 /> NALL� � d� �+g 5r� o <br /> (DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view)) Or" t6/ ,, D�w`��� tAee43 O 3 oC <br /> rN i.\. ret Ituc{wrc� /DU` n P Co <br /> 1. All required dimensions or distances to be shown or drawn to scale. `t 9(jj60' n o <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB)and indicate.-- <br /> m o <br /> North (N). y <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of m J.l <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. W <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildings, U� <br /> roads, lake, lot lines. i <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 SZ4 <br /> signed and dated by the owner. � co <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> N <br /> 2.O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. �1 <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W <br /> ISSUANCE. —j� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY D <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 /> 6. <br /> 7. <br /> z00 n 3 <br /> 8. <br /> 2- x <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m 0 : ; m <br /> PP ( g Y I Y Y <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy ofrd'n m V: G <br /> all information contained In this application(Including any accompanying schedule)and I further declare that I recognize ' m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> 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 o <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized personto ave access to the above d scribed premises at any reasonable time for the purpose of of injnsp/action. m !� <br /> SIGN HERE <br /> (signature o/own ulldl o <br /> ZONING ADMINISTRATOR <br /> TOWNS IP PERMITS MAY BE REQUIRED APR17017 N N N N m <br /> .N N N m <br /> o �n mo in <no <br /> i - i S OO S 0000 fA <br />