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U'l ( C , <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator d '0 0 0 <br /> ` APPLICATION FOR LAND USE PERMITS o <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- S2J <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> OWNER � TELEPHONE v q'Tis') ��/S S.S'�a <br /> HOME ADDRESS 4^ k5 �� S') <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> I ` I <br /> V <br /> -31 <br /> LEGAL DESCRIPTION(sea tax receipt) _ 31 _ rj � � � , <br /> CONTRACTOR , <br /> 0 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE—X,,,--�DDITION <br /> N Or <br /> O <br /> SANITARYPRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE:---i I`GlA) (i"l I I(fin I 6�a.,',(':5 / 1±21:i4 <br /> U <br /> (Home/Cabin; Commercial Business;Ilebroom;Deck;sic.) <br /> r <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR o <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) p <br /> 'n ? N <br /> T C <br /> 1. All required dimensions or distances to be shown or drawn to scale. ?5 <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB) and indicate m H <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 <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. I <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. 0C <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be _ r <br /> signed and dated by the owner. Co <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: o <br /> 3. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �1V <br /> ISSUANCE. -)n- <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 /> f <br /> 6. <br /> mtom[ DO1) <br /> 9 o,c �.� 5 $E� m <br /> 7. A m9dcyo33 <br /> `Z m O O <br /> Z <br /> 8. , _y : m <br /> m <br /> C <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my �- M : , m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of E T@ N 1 t7 <br /> all Information contained In this application(Including any accompanying schedule)and I further declare that 1 recognize o o <br /> that this Information I am providing will be railed upon by the County of Burnett Wisconsin In determining whether to Is- 50 $ : g <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett retying on this Information I am ( O p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to h ve access to the ove described premises at any reasonable time for the purpose of Inspection. T ? m E <br /> SIGN HE <br /> Ignsture of r 6und g ntrac ---(Be&F , <br /> ZONING ADMINISTRATOR <br /> TO SHIP PERMITS MAYBE REQUIRE . 1 <br />