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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator Cn - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <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- 3 <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. y m <br /> OWNERTELEPHONE m <br /> - kAU r &ver l�l.�-yy�-eaa� <br /> HOME ADDRESS 4�arriny(�i„ f-�°`�.SJ(j� -�9 <br /> 0-,3n F S,dIal, rr�Y � (faUzata mnl � ��1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) �� IICL//11i/V <br /> CONTRACTOR <br /> Lia � o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION X. o �-- <br /> � r <br /> N O <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION- <br /> 0 <br /> STRUCTURE/ADDITION USE: `xi r�e�1 PcyCjh IO X Ito/ <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. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) p <br /> T P m <br /> 1. All required dimensions or distances to be shown or drawn to scale. 0 o n <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB) and indicate In y: <br /> North (N). m �)4 <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of Uj <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM) of lake, stream or river. l r <br /> 4. Show the location of the well(%% septic tank(ST)and drainfield (DF), and all distances to buildings, +U�l <br /> roads, lake, lot lines. <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. Ij <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. m <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. ' ,1 <br /> o v/ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: g <br /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT n <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 F <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 /> 7. <br /> y o.c �.� �' <br /> W' i <br /> 5 `z N p : f0 ; <br /> 8. O FO Ty : =1 <br /> In <br /> � m 9 <br /> I 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 <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- ' <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 Information 1 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. ,n <br /> SIGN HERE <br /> es <br /> (signo/ntractor (date) <br /> ZONING ADMINISTRATOR g <br /> b : <br /> o <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 n o o In <br /> 0000ggoofA <br />