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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator m _ 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 N <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 <br /> 0 <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y m <br /> =cY✓ldrnl' T . lD�✓ SI` . <br /> TELEPHONE S ,4, <br /> R o A <br /> ,// //�� G 7 " C Q <br /> HOME ADDRESS 174 \/ Vi. a 7 S 1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) Ina Par tV E Yt' O E .SL L y C7 �\ <br /> Nv £ of yellaw (ver 1 <br /> lw <br /> CONTRACTOR �I <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE—ADDITION—IX-1— <br /> SANITARY— <br /> TRUCTURE ADDITIONSANITARY PRIVY FILLINj,,G/GRADING`' CAMPING UNIT SUBDIVISION- <br /> STRUCTURE/ADDITION USE: .IJ J rhe h/t I OOf �a I <br /> (Home/Cabin;Commercial Business; Bedroom; D dc;etc.) /D tri 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. m <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) p a <br /> m P (n <br /> m o <br /> 1. All required dimensions or distances to be shown or drawn to scale. t7 <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings (NB)and indicate m 9.i N <br /> North (N). y <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, 9 G� <br /> roads, lake, lot lines. <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. O I <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be DI <br /> signed and dated by the owner. (� <br /> 9J <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- n ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. m v , <br /> CONDITIONS OF PERMIT: R <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 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 /> 7. I m M 'W_W'. f, c 0 o''- a <br /> .0 < N 'Z N0 =10 <br /> N O <br /> = F T m <br /> 8. o = <br /> m <br /> O : 6 (_ <br /> a Zl <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my i 0: : m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of O <br /> all Information contained In this application(Including any accompanying schedule)and I further declare that I recognize ' PM O : <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 I am o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to h ccess to the above described premises at any reasonable time for the purpose of Inspection. <br /> SIGN HERE 14-30- 96 <br /> 1,9 (signature of owner or building contractor) ,(data) o E <br /> ZONING ADMINISTRATOR Ic}41�il�✓l •aha � <br /> C• r"PN �,, �+ N�y NrnN" Mom <br /> a��� <br /> TOWNSHIP PERMITS MAY BE REQUIRED ; o u v o m u u o m <br /> � o0000000fA <br /> I. � i <br />