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(9)�l 6VmI_� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator En 'o -I z <br /> APPLICATION FOR LAND USE PERMITS 2. j. ° <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 accor- fD ` <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. w <br /> OWNER 'j�vG E TELEPHONECD <br /> v O <br /> bra- W /6s8 0 <br /> HOME ADDRESS 6SolCD <br /> i <br /> TT J-.. /4�'loF1/q�- In-► 'nn sS3c3 9j <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) l U t <br /> CONTRACTOR o ` t E h S c_a F�r.�Try <br /> v <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTUR14 _ADDITION o' �. <br /> N 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> _ o <br /> STRUCTURE/ADDITION USE: ( 0y u 2t,JF- <br /> (Home/Cabin; <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> r <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR c <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> T <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> m o Cn <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). Co' <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of m i 7 <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, V <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 I <br /> signed and dated by the owner. <br /> 8 <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. ' W <br /> CONDITIONS OF PERMIT: UI <br /> v <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 z <br /> PERMITTED. (� ' <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE /yJ <br /> 5. `- <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> �a r n be, 63 <br /> OFc tJn r� tel— �l�`J_ 1 <br /> r /J / CJ G 1 l,c it !2 N M.0 r Q v M <br /> J W 4c R � `� em <br /> e/� C)r— 000 �� �C2o5 � <br /> 1. o f ° € TC : M <br /> Vi ca : <br /> b ! w ! € A <br /> i (OF <br /> declare that this application (Including any accompanying schedule) has been examined by me and to the beat of my ' ` ? ? m <br /> nowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of lift, m T i p <br /> II information contained in this application(including any accompanying schedule)and I further declare that I recognize : o m c <br /> iat this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to '• a . o <br /> ue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am <br /> roviding in this application. I agree to permit county officials charged with administering county ordinances or other ` °� <br /> uthorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> CD <br /> IGN HERE <br /> N <br /> (sign�otowner orbuilding contractor) (date) 0 <br /> o ; <br /> DNING ADMINISTRATOR �_ � ' n an' E o <br /> TOWNSHIP PERMITS MAYBE REQUIRED <br /> o (nNo�� orn <br /> m <br /> 0000000017) <br />