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CJS(., <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m "0 o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 1 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work m <br /> described and located as shown herein. The undersigned agrees that all work shall be done in accor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other 3 v <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> OWNER v TELEPHONE v l J <br /> S/I-'iFS t i �1ONG©KKE�/ 6 ►z -93i- k67CD <br /> m <br /> HOME ADDRESS,,,, ,,/ StAR11 <br /> D4 <br /> t b U6H A01r'1A1 S�Sf-/3> <br /> EMERGENCY/FIRE NUMBER R 8 6.717 ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) w/ a�I �Sm AOV,�, 1 T3 13— C/ri/5 <br /> CON CTOF, Pa } I e `7��� W2 S � M /lJ o <br /> � (9 C7 <br /> G) <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE—ADDITION--,X,,,- 8 d <br /> W .Q.. <br /> SANITARY PRIVY FILLING/GRADING AMPING UNIT SUBDIVISION <br /> — <br /> Z o <br /> CD <br /> STRUCTURE/ADDITION USE: � <br /> arcr� <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) <br /> o_ <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 <br /> n a <br /> 1. All required dimensions or distances to be shown or drawn to scale. 0 ? 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). 0 I D <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 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 l <br /> signed and dated by the owner. U I U <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. 2. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: _v <br /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 Z <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 /> o c M cn 0 D m <br /> 7. rel �$ � •amm <br /> d C y 0 <br /> a �No ? wo 3 <br /> Z N <br /> 8. C m <br /> v S7 0 <br /> C3 <br /> : m <br /> i m ° ` C <br /> COD. <br /> : M <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of y m <br /> all information contained In this application(including any accompanying schedule)and 1 further declare that I recognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 I a n p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 8 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. �pT ` CD <br /> ; y <br /> N <br /> SIGN HERE <br /> N : <br /> (signature of owner or building contractor) (date) c <br /> �' . o <br /> ZONING ADMINISTRATOR ill(11141 <br /> . NNtn NNNfJi m <br /> TOWNSHIP PERMITS MAY BE REQUIRED m <br /> 000 $ 0000rn <br />