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0A CDor, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ,� - 0 0 <br /> APPLICATION FOR LAND USE PERMITS d 3. <br /> T <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for this work vN <br /> described and located as shown herein. The undersigned agrees that all work shall be done in ccor- 3 C I <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with al other o ` <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. N m <br /> y� /n�(J 8 <br /> OWNER JO N { C R(, L S O YII TELEPHOREc - 7/5—- YAP— m <br /> m <br /> m <br /> HOME ADDRESS S701q 40L YD') N 5-S y <br /> y <br /> EMERGENCY/FIRE NUMBER // /s ROAD NAME I/ L 0 <br /> ow � L Rd 3 <br /> LEGAL DESCRIPTION (see tax C L../ S E -S- ,,c- <br /> CONTRACTOR <br /> FCONTRACTOR 1 4. { fes, J-- wA) o .v <br /> m G) <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE—K_ADDITION 0 <br /> N <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> Z 43 <br /> STRUCTURE/ADDITION USE: ieG - O <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 C R <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> O <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> m a <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 S <br /> North (N). m <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerlina of <br /> road, (c) building(s) measurement to the ordinary high water mark (OHWM) of lake, stream or river. �1 <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. <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE <br /> -FORE A PERMIT CAN BE ISSUED. L_ <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 PERMI s 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. D <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF HE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> F <br /> 6. <br /> (n (n � (nr > D <br /> 7. O <br /> M oc =.NW= o � f m <br /> M <br /> S <br /> 2 T+ <br /> moE �Z 1 <br /> 8. c f = ' _ rnE i 70 <br /> d : m <br /> D <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the bes of my I O ' ' <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and aeeu ae of m <br /> 9 P 9 P Y <br /> all information contained in this application(including any accompanying schedule)and I further declare that Ire(ognize o o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining wheth4 r to is- .b b ; <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 informati n I am n p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances other 3 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of insp ction. <br /> m i i i in i <br /> SIGN HERE <br /> (altur of owner or_bujiding contractor) :; SP <br /> (date) o <br /> ZONING ADMINISTRATORS `�� I . o . . <br /> J ,,i �NNN N pim <br /> TOWNSHIP PERMITS MAY BE REQUIRED o0 0 0 o D o m <br /> 00000 to <br />