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N evyy . <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator w - -- 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work N <br /> described and located as shown herein. The undersigned agrees that all work shall be done inccor- e <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with al other 3 0 <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> 9 <br /> n Rn <br /> OWNER �d 0 V� ��� TELEPHONE p <br /> VVV <br /> m <br /> HOME ADDRESS <br /> i <br /> EMERGENCY/FIRE NUMBER 5 / ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) /JSm �� • �l� <br /> CONTRACTOR 1. <br /> 0 <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE—ADDITION-K— o � <br /> 0 ^ <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o � <br /> m _ <br /> STRUCTURE/ADDITION USE: - Q1 (� <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <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 /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) p B <br /> m a 0 <br /> TZ <br /> 1. All required dimensions or distances to be shown or drawn to scale. P <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate m La <br /> North (N). m 1 <br /> 3 .Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of U. <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. `, Uj a <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. S <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION E E- ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> 2. <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 <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 Q )p <br /> PERMITTED. <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 /> 6. <br /> NW v(nrD DF <br /> _. m <br /> 7. 9� � � : u+ cNo � 3 <br /> : <br /> 7• F = cn : m <br /> 8. o - m <br /> o m� O <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the be t of my i <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and acc racy of �;m r`^„ O <br /> all information contained in this application(including any accompanying schedule)and I further declare that Ire ognize <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whet r to i 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 infonnati n 1 sm n [ o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances r other 3 <br /> authorized o have access to th ve described premises at any reasonable time for the purpose of Ins action. <br /> N N : <br /> SIGN <br /> (signs of owner or building contractor) (date) o <br /> e O i i <br /> ZONING ADMINIST TORin n <br /> E i i i i <br /> 00 ,vNi WORM <br /> OR <br /> TOWNSHIP P RMITS MAY BE REQUIRED o 0 0 0 0 0 0 o m <br /> 00000000 (A <br />