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no 07f ) <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator rn � o 0 <br /> APPLICATION FOR LAND USE PERMITS3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work Q N '9 <br /> C <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. <br /> � m <br /> OWNER T60 <br /> mas �rriQr TELEPHONE 6$4_ Z(47 dCD <br /> Td � <br /> HOME ADDRESS tii4-ZJ SPIRI-T LRkE RD W FRE.DERI WI 54837 <br /> EMERGENCY/FIRE NUMBER 1 I4Z� ROAD NAME ur <br /> 48h/Z•r 540/474 L <br /> LEGAL DESCRIPTION(see tax receipt) So 3/ 3'!/ i2 1%w acfie i S.4z0 T <br /> - 37 -oR -•n3 -O 0Z I l0 N450 O.0 E 3Z$ IJC SE <br /> CONTRACTOR Um Palmer <br /> CD <br /> o u <br /> TYPE OF PERMIT(S): DWELLING/BUILDING __GARAGE/ACCESSORY STRUCTURE ADDITION c <br /> N Or <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> - <br /> 0 E3 <br /> STRUCTURE/ADDITION USE: U-0-in Q_ <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. m <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> O 3 <br /> m p � <br /> 1. All required dimensions or distances to be shown or drawn to scale. n o a <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB)and indicate m y: <br /> North (N). N 0 1 1 1 <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. V <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. Ui <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. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. f. ; <br /> o �J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W <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. :b <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE 7� <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. W <br /> 5. <br /> 6. <br /> rnmvrnrDDo <br /> 7. g °'iT,�' > > caEm <br /> l �3s 3 <br /> a am <br /> Sed SA'N 9 . y <br /> 8. l/ / Z F ' "ren : i <br /> ° �» m <br /> �s tea : <br /> m m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m ; p <br /> all information contained in this application(including an accompanyingschedule and I further declare that I reco nize n <br /> PP ( 9 Y ) g o � o : <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 /> 0: v <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ; 3 <br /> authorized person to have access to above a premises at any reasonable time for the purpose of inspection. ,n '• i im <br /> N N <br /> SIGN HERE <br /> N <br /> gn ure of owns o building co or) (date) oo <br /> ZONING ADMINISTRATOR <br /> 0 <br /> vitn� " <br /> W O O N tNJI M <br /> TOWNSHIP PERMITS MAY BE REQUIRED �tbbbbbb ' <br /> 0000000 <br /> UT In <br />