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0y1 C')- <br /> Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Off lcf of Zoning Administrator w -0o 0 <br /> APPLICATION FOR LAND USE PERMITS a 3. <br /> 0 <br /> 70 THE ZONING ADMINISTRATOR: The undersigned hereby makes applicati n for a Permit for the work <br /> described and located as shown herein. The undersigned agrees that all work shall be done inaccor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other <br /> 0 <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> c `? <br /> OWNER �/ ` TELEPHONE Ci U` <br /> L+AJ5� fl" <br /> � o m <br /> HOME ADDRESS Q / Z; <br /> EMERGENCY/FIRE NUMBER ROAD NAME rt <br /> LEGAL DESCRIPTION(see tax receipt) ( <br /> NC�r s/oT38,UR17� r).v,�/s `N <br /> CONTRACTOR o <br /> G21 Z <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION 0 »- <br /> N O <br /> O <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o v <br /> C l � <br /> STRUCTURE/ADDITION USE: <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. AkNY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T -44 <br /> v f <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) C <br /> T p N <br /> 1. All required dimensions or distances to be shown or drawn to scale. F)9 <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB) and indicate m y <br /> North (N). (a ° <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of m P!r <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, 1 / . <br /> roads, lake, lot lines. C� J) <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or llled. C �1 <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be O <br /> signed and dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONS TE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. W <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 9 <br /> PERMITTED. <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 /> 6. <br /> � / mmvmr Doy <br /> 7. <br /> C y O j <br /> N O <br /> 8. <br /> -L <br /> o — <br /> o ` <br /> I declare that this application (including any accompanying schedule) has been examin d by me and to the best of my ; m <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsib a for the detail and accuracy of <br /> all Information contained in this application(including any accompanying schedule)and further declare that I recognize1` m <br /> � <br /> that this Information I am providing will be relied upon by the County of Burnett Wiscon in In determining whether to Is- V o , o <br /> o : o : <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett elying on this Information I am ^ p <br /> providing In this application. I agree to permit county officials charged with administe ing county ordinances or other , 3 8 <br /> authorized person to have access to the above described premises at any reasonable tim P for the purpose of Inspection. m,t E i E ii N <br /> SIGN HEREe—1. 401 <br /> N ; <br /> (signature of owner bulikiln c t tor) (date) o <br /> ZONING ADMINISTRATOR p g : ` `• <br /> in tswj'tn"F»o m <br /> N N r n N N N N <br /> TOW SHIP PERMITS MAY BE REQUIRED p <br /> 000000oou) <br />