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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator w - o 0 <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 accorTL <br /> - <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. <br /> 8 <br /> OWNER /� r //NS TELEPHONE Q <br /> HOME ADDRESS4�5 P49?1 Poe 7 S % <br /> EMERGENCY/FIRE NUMBER ROAD NAME apl :�i Kd n <br /> LEGAL DESCRIPTION(see tax receipt) 5 _N 441 A-NA/!V � <br /> - 9 ' " 9 <br /> r <br /> CONTRACTOR 0 <br /> x 20 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION �- <br /> W rC <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION- <br /> STRUCTURE/ADDITION <br /> UBDIVISION STRUCTURE/ADDITION USE: ' '-TC' ) QQ 0/0 / ' &del aoarce v <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) <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. "n <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 <br /> cp <br /> 21 Z S <br /> 1. All required dimensions or distances to be shown or drawn to scale. m P <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings (NB)and indicate <br /> North (N). mu <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of m i <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 buildings, <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 must be C <br /> signed and dated by the owner. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- Q <br /> FORE A PERMIT CAN BE ISSUED. (� <br /> 0 <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 <br /> ISSUANCE. O <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 THE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> 6. S07 <br /> CL CD M <br /> CD <br /> U) 'z N p =f0 S. 3 <br /> O E T�: M <br /> 8. �� : O <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my O f <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of i',(m V C <br /> oro o : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o m o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 0 : 0 ; <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 : 0 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. T m <br /> w i <br /> SIGN HERE N <br /> o ; <br /> (signature of owner or building contractor) (date) o ; <br /> ZONING ADMINISTRATOR <br /> Fn i»ul ro <br /> 0 N N N N N N f 7 m <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 PPP .`n o 0 <br /> 00000 $ 000 <br />