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bn Cts,-ry <br /> urnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator d m -- 0 <br /> APPLICATION FOR LAND USE PERMITS3 <br /> � o <br /> D THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work , <br /> ascribed and located as shown herein. The undersigned agrees that all work shall be done in actor- 3 <br /> ante with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other o <br /> 3plicable County Ordinances and the laws and regulations of the State of Wisconsin. c _ <br />✓yNER " U /,A�/ -LAW '7!6�- ?J /+2Z <br /> / �� <SnD/��I� TELEPHONE - �3tS-- '730 w m <br /> DME ADDRESS <br /> go R Su /JU0_0#W SHr Pt(/ <br /> dERGENCY/FIRE NUMBER ` //,,5- <br /> ,g f" ROAD NAME ����S-O� 'A0� <br /> LOT- /7r r-Lfr OF J771-GSdti!' rAP6t; 7C <br />:GAL DESCRIPTION(see tax receipt) 7-c- 3 s47- <br /> 7 <br /> OM 3� 07 —07-706 <br />)NTRACTOR t/It ,t/�= D� 0� o <br /> r ` <br />'PE OF PERMI (S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION o - <br /> tNITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION 'c o <br /> t�encbv7/ N of <br />'RUCTURE/ADDITION USNE/u 12)/Af ROOF Kj <br /> Tdt ' <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) � y R Af iJQ <br /> PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> LEGIBLE PLOT PLANS WILL BE RETURNED. m js <br /> O <br /> RECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) A <br /> O 3 <br /> 'n P u <br /> All required dimensions or distances to be shown or drawn to scale. n o a <br /> Show the location and size of all existing buildings (EB)and all new buildings (NB) and indicate m <br /> North (N). y <br /> 0. <br /> 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. r <br /> Show the location of the well(W), septic tank(ST) and drainfield (DF), and all distances to buildings, ,y <br /> roads, lake, lot lines. <br /> Indicate if a walkout basement is planned and show areas to be graded or filled. <br /> If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be x <br /> signed and dated by the owner. (n <br /> I <br /> ig <br />)TE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- 0 <br /> FORE A PERMIT CAN BE ISSUED. N <br /> IIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. m <br />)NDITIONS OF PERMIT: o <br /> DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> NO.GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 7U Z <br /> PERMITTED. 1 a <br /> NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE CIO <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> F <br /> u)co DD y <br /> M o, c �. � � A � m <br /> R DS� Qy 5' <br /> = F 21 1 <br /> N i 2 : In <br /> O : m C <br /> iclare that this application (including an accompanying ' M <br /> PP ( g y panying aehedule) has been examined by me and to the best of my � ? m <br /> iwledge and belief It is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of <br /> Information contained in this application(including any accompanying schedule)and 1 further declare that I recognize o o <br /> t this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is. <br /> 0 . o <br /> a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am C): 0: <br /> viding In this application. I agree to permit county officials charged with administering county ordinances or other 3 R <br /> horized person to have access to the above described premises at spy reasonable time for the purpose of Inspection. m ': v m : <br /> m <br />!N HERE <br /> signature olilmwdhor or building contractor) <br /> VING ADMINISTRATOR <br /> In <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />