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60 <br /> Burnett-County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator d - o o <br /> APPLICATION FOR LAND USE PERMITS 3. <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- fD <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. H m <br /> OWNER e� /y� AJe TELEPHONE o <br /> m <br /> HOME ADDRESS L I <br /> EMERGENCY/FIRE NUMBER LJ� '� (J ROAD NAME <br /> LEGAL DESCRIPTION (see tax cre eiptt) (.CIO14,UoI�-SV `1� LSC Yiii111111 <br /> CONTRACTOR <br /> 0 <br /> a <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION »' <br /> y O <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> Z $0 <br /> STRUCTURE/ADDITION USE: Q0 Ajq Uinc, /I(ge <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. T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> T F m <br /> O <br /> 1. All required dimensions or distances to be shown or drawn to scale. n C<- <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings (NB)and indicate m y: <br /> North (N). 0 R <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of m t� <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. �' o 0 <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildings, O '� <br /> roads, lake, lot lines. 4i C <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 /> C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- O ° <br /> FORE A PERMIT CAN BE ISSUED. 2. <br /> (� <br /> r <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W <br /> ISSUANCE. 16 cx� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY I z <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. /n-t[� j- bora -t SOC /Vo Ca�OSer fa f��LU/f"l. 'ka'� bryds4p j dG.,eC.Y!^-lY" _ <br /> V f <br /> 6. <br /> 9 o c N a F m <br /> _. <br /> 7. � 9a ' m .. _ M <br /> °. < ya <br /> d W <br /> 8. )2-13(So �v �03M <br /> 2i i m <br /> o : � C <br /> �1 � m M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my x! m <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of y E O <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 /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am <br /> providing in this applie . I agree to permit county officials charged with administering county ordinances or other ; [ <br /> authorized person to hale cess to the ove described premises at any reasonable time for the purpose of inspection. m H i <br /> SIGN HERE FF � <br /> ( na of owns r Iltling contractor) (date) o <br /> 0 <br /> ZONING ADMINISTRATOR <br /> T <br /> N N n0 m <br /> N N 0 m <br /> N U <br /> TOWNSHIP PERMITS MAY BE REQUIRED cO o 0 0 0 0 0 0 <br /> P T 0 tP rA <br />