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�X (-"0 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator d 'o 0 0 <br /> APPLICATION FOR LAND USE PERMITS d 3. <br /> 0 <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- m <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other 3 0 <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y <br /> OWNERTELEPHONE 7/'S <br /> 6S? 1�1/S d 1 <br /> HOME ADDRESS f <br /> 71SS .14ti'f <br /> EMERGENCY/FIRE NUMBER a� 7 / ROAD NAME <br /> / // ( y. u nn. J <br /> LEGAL DESCRIPTION(see tax receipt) 60V Lc"� S S, 3S ! .1'�I /C IS W 1 <br /> CONTRACTOR <br /> �Ue.-Lli✓A1lYte/.i�l . <br /> m O <br /> a <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE-,-KI—ADDITION—,,--V— <br /> SANITARY— <br /> TRUCTURE–,-KI—ADDITION_,SANITARY PRIVY FALLING/GRADING CAMPING UNIT �UBDIVIS/I�IOON /_ 1U <br /> STRUCTURE/ADDITION USE: F' /ni �y rcdi+r I✓i/1./1�, ��/t'1 ll��C '�.� o <br /> 4i (51 <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etd.) VJ <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 /> o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O a <br /> n P rn <br /> 'nc <br /> 1. All required dimensions or distances to be shown or drawn to scale. p o n <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB)and indicate m <br /> North (N). Iin <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) uilding(s)to centerline of m SO <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. 9J a <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and II distances to buildings, 4� <br /> roads, lake, lot lines. <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. Q <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be y <br /> signed and dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSItE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. <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 �0 DAYS OF PERMIT » <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 713 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UN LES SPECIFICALLY n <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWEDTHIN 75 FEET OF THE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTEp. <br /> 5. <br /> 6. �Rl�ind� , � ,,Irl� fErm �--I4 <br /> '. y n > f T <br /> 7. a� am m 70 <br /> a 5' T� <br /> 0 Z U <br /> eE N <br /> 8. I,,, N 32- 1 M <br /> of ami C <br /> O € Io <br /> I declare that this application (Including any accompanying schedule) has been examin d by me and to the best of my In <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsib a for the detail and accuracy of E . <br /> om o <br /> all information contained in this application(including any accompanying schedule)and further declare that I recognize o �^ o : <br /> that this information I am providing will be relied upon by the County of Burnett Wiscons in In determining whether to is- i i 0i <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett 'elying on this information I am O : 0 <br /> providing in this application. I agree to permit county officials charged with administel ng county ordinances or other 3 $ <br /> authorized person to have cess o t ove described premises at any reasonable tim for the purpose of inspection. <br /> $ mi <br /> s/oAy6 H <br /> SIGN HERE N' <br /> (slgVlature of ow or or building contractor) (date) ; o i E <br /> ZONING ADMINISTRATOR ( V 1(7t 11 kil: : ? o <br /> N -n <br /> TOWNSHIP PERMITS MAY BE REQUIRED o o ao 0 0 0 o m <br /> 0 0 0 0 0 0 071 <br />