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I.G�Y I�Jt.I/ <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0CD <br /> I o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> z <br /> TO'THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work U y <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- R <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other 2 <br /> v <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y ?: <br /> OWNER ` I_ �LaJ L/ Z TELEPHONE P`d _ 7�'a m <br /> v m <br /> HOME ADDRESS b)ru <br /> EMERGENCY/FIRE NUMBER SA /►'t-vim ROAD NAME <br /> J <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CONTRACTOR <br /> 3 ;Cl—— W 0 G <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE— <br /> SANITARY- <br /> TRUCTURE SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> a _ <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <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. nl <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> m a m <br /> T o cr <br /> 1. All required dimensions or distances to be shown or drawn to scale. 0 <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB) and indicate m > c <br /> North (N). m <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. r 10 <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildings, 0 <br /> roads, lake, lot lines. J <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 <br /> signed and dated by the owner. <br /> Q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- O °_ <br /> FORE A PERMIT CAN BE ISSUED. <br /> 2.N <br /> 0 <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 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 /> 6. Vdri-ance <br /> o c m d 8 a m <br /> 70 _ Q� '- 'am a � m <br /> 7. m mH00 an <br /> 8. o <br /> -•to <br /> o : ate : C <br /> o CDM : <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my '• G) <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of M m CA m <br /> 9 P 9 P Y � u, iu v, <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ti <br /> o . o <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 n o <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. m <br /> / N <br /> SIGN HEREk 7_L -9! « . N <br /> (signature of owner or building contractor) (date) o <br /> ZONING ADMINISTRATOR �J IfYI 1 I�f I Itl ° ' E E i i E <br /> (nvi�Fnt»iaj' 'n <br /> NN (INN 9) (n m <br /> TOWNSHIP PERMITS MAY BE REQUIRED 00 <br /> 00`0 00 v, (n m o m <br /> 0000 <br /> 000000009) <br />