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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator rn ' 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 y <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- 3 <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. y m <br /> / c V <br /> OWNER IZI <br /> O / _ Z 0 ) TELEPHONE <br /> HOME ADDRESS /� //�� L # <br /> EMERGENCY/FIRE NUMBER � � )6) ROAD NAME 1',ed of P/`,N'�1C <br /> LEGAL DESCRIPTION(see tax receipt) <br /> -�. 1 esnn (20 ( �',0�, 13� a9-32-19) <br /> CONTRACTOR S-e '- o r <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION -r <br /> N y <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING NIT SUB ISION <br /> /I��-� / !�,f41NIT q raj /- <br /> STRUCTURE/ADDITION USE: l7uC- Piti'�3,? YSG i oCc� �J� &4^�Ov� fi le y/07 <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. In <br /> O <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> n P rn <br /> -nZ <br /> 1. All required dimensions or distances to be shown or drawn to scale. n P <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB)and indicate m y <br /> North (N). y I n <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) building(s)to centerline of m (7) <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM) of lake, stream or river. R V) -o <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all 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. <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. 'CO <br /> R <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> 2.0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> N k� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT n �; <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 Z <br /> PERMITTED. D <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. IVO V1 II1r.5 C)-F t_,�t�a�d Arr„t, <br /> 6. �I �KSI(Jas�'ri SZ7eCauwf /)-ft'l 4z� kle SeecYecf 6r1lu �t cX f <br /> 51'?,"- Sodas 'C'e be /:�¢l Flo p Slee/� , ae/s L i <br /> n I / �.l.,_ L lV u UVu ME <br /> 7. I'r 1 Corus T1�.1 I� r11¢.ei �o Wis (-(.ML rr-�. tip , p o c �. w� g $ f m <br /> d - �� am .: 1D 70 <br /> o 0,'0 3 <br /> 8. lj�Uln4l �l�G°< /tc,l I� Cie 7f,�G.�137s� (� — o € cn € m <br /> T <br /> cg : i m <br /> Si a� C <br /> o ; <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my O <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of N m N; O <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I roeognize . o o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to I - b . o <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 [am p <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other iQ <br /> authorized person to 11ave,access to the above described premises at any reasonable time for the purpose of Inspection. m ? m E <br /> SIGN HE E w <br /> N <br /> Ig lure of m or building c ctor) (date) S <br /> O <br /> ZONING ADMINISTRATOR <br /> �NNtn NNNN m <br /> TOWNSHIP PERMITS MAY BE REQUIREDo 0 0 0 D o m <br /> 0000SSCOW <br />