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6--f) �/ <br /> Burnell County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator d 0 0 <br /> APPLICATION FOR LAND USE PERMITS d 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work 0 y <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor• 3 n <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 /> m <br /> OWNER - TELEPHONE <br /> m <br /> HOME ADDRESS - ) <br /> EMERGENCY/FIRE NUMBER ROAD NAME J <br /> C> e I-J 1 <br /> LEGAL DESCRIPTION(see tax receipt) 60y.-?�_ <br /> CONTRACTOR SEGf `t <br /> q <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTUREADDITION � <br /> m -°r. <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT �SUBDIVISION <br /> z <br /> STRUCTURE/ADDITION USE: l JI1JC,�CJ� <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. NY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O <br /> -n a c <br /> T O a <br /> 1. All required dimensions or distances to be shown or drawn to scale. n <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB) and indicate m y <br /> North (N). y (�y <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) 4uilding(s)to centerline of m I ) t l <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 311 distances to buildings, _ <br /> roads, lake, lot lines. ZZ <br /> 41 (�( <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or Iiilled. I 1 <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractdr, etc., the plans must be <br /> signed and dated by the owner. v <br /> R <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONS11TE 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 /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN ¢0 DAYS OF PERMIT <br /> ISSUANCE, <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTEALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLES SPECIFICALLY ? <br /> PERMITTED. I D <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED�THIN 75 FEET OF THE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFIC <br /> 5. <br /> 6. <br /> y oc 3.m0D £ m <br /> 7. m mp1cyS � 70 <br /> Z E [ TCA <br /> >7 <br /> 8. o <br /> C <br /> om m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G7 [ <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsib a for the detail and accuracy of y N C) <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize i o o <br /> that this information I am providing will be relied upon by the County of Burnett Wiscons n in determining whether to is- ` o o <br /> o : o : <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett 'elying on this Information I am O p <br /> providing in this a . I agree to permit coun cials charged with administer ng county ordinances or other 3 <br /> authorized perso to have access to the above desc a premises at any reasonable tim for the purpose of inspection. <br /> SIGN HERE v+ <br /> N ; <br /> �(eigna ure o r r building contractor) (date) i <br /> ZONING ADMINISTRATOR �JI(Tl 1 I C <br /> N N N N mom <br /> t m <br /> TOWNSHIP PERMITS MAY BE REQUIRED p v o m <br /> 0000 000 <br /> 0000 ooN <br />