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5� <br /> Burnett County 7410 Co. Rd. K,No. 102, Siren,WI 54872 Office of Zoning Administrator m ; 0 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 accor- 3 FLdance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other <br /> applicableCountyOrdin ces and the laws and regulations of the State of Wisconsin. y m v <br /> Y v 7W f ie+SO/% `? r n <br /> OWNER TELEPHONE <br /> HOME ADDRESS Z—" ��/ v <br /> EMERGENCY/FIRE NUMBER 2G ROAD NAMI�_?/ <br /> LEGAL DESCRIPTION(see tax receipt) 'C 7— T / <br /> 6cv�T <br /> CONTRACTOR <br /> o <br /> TYPE OF PERMIT(S):DWELLING/BUILDING--X—GARAGE/ACCESSORY STRUCTURE ADDITION <br /> tl 0 <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: I Vew <br /> 4n-�� �')3 J7� <br /> (Home/Cabin; Commercial B1C) r1b <br /> usiness;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. In <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> O 3 <br /> m p C6 <br /> 1. All required dimensions or distances to be shown or drawn to scale. n o g <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB)and indicate m H: <br /> North (N). N <br /> 3. Show dimensions in feet of the following: m <br /> (a) building(s)ng(s)to all lot lines, (b) building(s)to centerline of <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. a )- <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. 0 <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be W <br /> signed and dated by the owner. 6 N <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. pp_" ` <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> to <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 ? <br /> PERMITTED. :b <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 FEET OF THE <br /> 5. OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 6. <br /> rn!n V l/J D D 0 M <br /> 7. M � A Fm <br /> 2' CL CD <br /> < N '2 N O f0 <br /> 8. _' o • : "2 : <br /> d, i 2 i m <br /> A <br /> oma : '• aS C <br /> CD m • <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my = m; <br /> In <br /> knowledge and belief it Is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of v m �„ p <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize o o <br /> o : <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- �,{ $ o : <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 �N n v <br /> providing In this application. I agree to permit c officials charged with administering county ordinances or oth 3 <br /> authorized person to have a cess the above escrl d p ises at any reasonable time for the pur ose of inspectlon, m <br /> m '9 . <br /> SIGN HERE I ~ w: <br /> ( n ure of owner ilding contractor) <br /> ZONING ADMINISTRATOR <br /> g <br /> . ,' ;� inE»ind'iflwX11 <br /> NIVpNN C, <br /> TOWNSHIP PE MITS MAY BE REQUIRE '3 I0080080 <br /> u m o v v o <br />