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Burnett•County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator d 0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work 0 m <br /> described and located as shown herein. The undersigned agrees that all work shall be done inccor- g TL <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other 3. o / <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> n <br /> OWNER \ r { - TELEPHONE C-) p m <br /> HOME ADDRESS 1� ` J \ 1 -� - Goo d� \ V rn <br /> 1 11 <br /> ct— <br /> EMERGENCY/FIRE NUMBER UC-\to -)C) ROAD NAME 1 <br /> LEGAL DESCRIPTION (see tax receipt) 50C 4 i l PTC RFJ) <br /> CONTRACTOR QP <br /> 0 <br /> 0 a <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> 0 r U <br /> O ft <br /> SANITARY PRIVY FILLING/GRA ING CAMPING UNIT SUBDIVISION <br /> z <br /> o $ <br /> m <br /> STRUCTURE/ADDITION USE: C Q <br /> (Home/Cabi ; Commercial Business Bedroom;Deck;etc.) <br /> r <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O l� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> T 'p m <br /> T Z S <br /> 1. All required dimensions or distances to be shown or drawn to scale. o a <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB) and indicate m N' <br /> North (N). w 9-) <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. (� <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildir gs, $L (f <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 C <br /> signed and dated by the owner. _ R <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION B - <br /> c, <br /> FORE A PERMIT CAN BE ISSUED. LJ <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 SHORELIN E. Z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Z <br /> PERMITTED. — <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN l75 FEET OF THE � <br /> 5. OHWM OF LAKES, <br /> EA NDS, RIVER 1 TS} CSI4UNLESS SPECIFICALLY <br /> �T PERMITTED <br /> 6. /16 �r2 Cc-, lM z 4 We .�5''�- ow -o m g a n F � <br /> 7. � ? kT JA m o a, iF QM E m M <br /> V � m m yZ m o pro 3 <br /> Z f J ?IN: ' M <br /> 8. P m <br /> o <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the bes of my m : m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and scot racy of E y' <br /> all information contained in this application(including any accompanying schedule)and I further declare that Ireognize . o o <br /> o , o : <br /> that this Information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining wheth r to is. <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 admini ? 3 2 i <br /> authorized person to have cess to the above de cribed premises at any reasonable a 61 M <br /> ''rymry <br /> SIGN HERE lI H i i <br /> en i <br /> (signature of owneror building contractor) (d 1 o <br /> ZONING ADMINISTRATOR <br /> lao I 1ti <br /> N N N N N N m <br /> TOWNSHIP PERMITS MAY BE REQUIRE - 0 .0 <br /> 0 0 0 0' o <br /> 000000 0, <br />