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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoon'ing Kd"rHi � E o o <br /> APPLICATION FOR LAND USE PERMITS <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- (D <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. H <br /> OWNER C � � T PHONE / � v <br /> C aJ VRLt�C i!_ srjgLTZAK fH jjr 6� I' 8QC Ho <br /> HOMEADDRESS <br /> 7q Sc H4LLf OP.Ug PL-L,1/6 4voocl <br /> EMERGENCY/FIRE NUMBER a �/ ' S> I) 9 ROAD NAME <br /> LonS• Lyf(� n" <br /> LcT-1 CS y,, u�►'�s`l iO-trcrcCtc o7-03 ''2- `il-It -dd-cnyiao �j <br /> LEGAL DESCRIPTION(see tax receipt) (b-2 C S 9S9 -/0rIC,F tc u O7-07 � -/c1 4) <br /> -�- /r -.3J-oey> (/- <br /> CONTRACTOR <br /> i� o V1' <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE—k—ADDITION d `Vt< <br /> y do <br /> o W^ <br /> SANITARY ' PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION '' Z _ <br /> o <br /> STRUCTURE/ADDITION USE: G 4 6 h h E 4i act P-4 <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) <br /> 1 <br /> in <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 J <br /> P ICD <br /> 1. All required dimensions or distances to be shown or drawn to scale. o Cr <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB)and indicate m ` 1 H: <br /> North (N). y 0 <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of M <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM) of lake, stream or river. II , <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 1 T' <br /> a <br /> signed and dated by the owner. <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. <br /> CONDITIONS OF PERMIT: v G <br /> N <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. 70 <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. <br /> r�rn -vrnDDv <br /> rn <br /> -a7. <br /> y c M. 8 F m � �' T� <br /> < N 2 N Q <br /> 8. Z 7 T <br /> o <br /> C ; W C <br /> P . m m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m <br /> PP ( 9 Y ) Y Y m . <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of w <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 I am �p '- <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. w <br /> T : v <br /> SIGN HERE a Lo '0t�vuk_ <br /> (signature of -orb Idl clot) (d e) No <br /> ZONING ADMINISTRATOR 33 03 <br /> o : <br /> ANN C—A'No tJi m <br /> TO NSHIP PERMITS MAY BE REQUIRED o . . o . v • o m <br /> 88888 8 ,00 <br />