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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Adminisl rator d o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> s <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit forth z work y <br /> described and located as shown herein. The undersigned agrees that all work shall be done in 1 ccor- q <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other 3 <br /> 0 <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. � n; <br /> OWNER tv- ti TELEPHONE <br /> HOME ADDRESS <br /> I �1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME 0 <br /> LEGAL DESCRIPTION(see tax receipt) 5 IL <br /> U`I <br /> CONTRACTOR Y o n <br /> T 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE—K ADDITION 0 <br /> y O <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION— <br /> Z <br /> / Z o <br /> STRUCTURE/ADDITION USE: <br /> l�L� I 6 o <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. m <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) p 3 <br /> m 'R W <br /> 1. All required dimensions or distances to be shown or drawn to scale. o <br /> n <br /> Cr <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate M <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 buildi gs, <br /> roads, lake, lot lines. (y 0 Z <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 1( J <br /> signed and dated by the owner. Cj <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION B - DQ <br /> FORE A PERMIT CAN BE ISSUED. <br /> ii Lvt <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> W <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 ? <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. <br /> Nrn -0rn > > y <br /> 7. & <,. rnm <br /> Cyo5 <br /> p Q <br /> = f o T <br /> 8. o 71 n : 7p <br /> N 62 : m <br /> O <br /> m m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best 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 recognize <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 () p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances o other 3 ; 2 <br /> authorized person to ave access to the above described premises at any reasonable time for the purpose of Inspection. T i v w E <br /> m : <br /> is <br /> N <br /> h'l ' ! m <br /> SIGN HERE b <br /> N ; <br /> (signature of wn or building contractor) (date) o <br /> � (1 0 : <br /> ZONING ADMINISTRATOR co <br /> -n <br /> TOWNSHIP PERMITS MAY BE REQUIRED N U Np N N f 1. Np N N N m <br /> O O O <br /> 0 0 0 0 0 0 0 0 y <br />