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cy? <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator rn m o 0 <br /> APPLICATION FOR LAND USE PERMITSso <br /> . <br /> s <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit forth a work " <br /> p <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with a I other = o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. H m <br /> c �? <br /> OWNER /J R T LEP NE -y s o n <br /> m <br /> m <br /> HOME ADDRESS �01 -14 Ale S <br /> (� <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> C1 1 i1NG L 7C <br /> I 0 <br /> LEGAL DESCRIPTION(see tax receipt) S� !G l N GV <br /> CONTRACTOR <br /> L o <br /> n p _ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE_�<_ADDITION 0 <br /> mior <br /> O <br /> SANITARY PRIW FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> - <br /> Z ° <br /> 1 m <br /> STRUCTURE/ADDITION USE: a i✓! 110 '� I <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) C <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. OO . <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 <br /> p rn V I <br /> 1. All required dimensions or distances to be shown or drawn to scale. o a <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 °, <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerlin of m I <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. (n r <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildi gs, SZ) <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 mus beJ r <br /> signed and dated by the owner. _ .0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE <br /> -FORE A PERMIT CAN BE ISSUED. `J l r ` <br /> o XJ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. (`�.i <br /> CONDITIONS OF PERMIT: o <br /> m <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMI <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 ? <br /> PERMITTED. , D <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 FEET OF HE Y <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> f <br /> 6. <br /> / �j yc�Nm DD n7 <br /> 7. f e �Lof TL*CJS A 2.cul a= M <br /> <,m, `� m p O=3 <br /> 9 N O <br /> PQ -1 <br /> 8. p E T N <br /> € cue : m <br /> dam ' c <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the beal of my ; m : m <br /> knowledge and belief It is true,correct and complete. 1 acknowledge that I am responsible for the detail and accu icy of u, m �'„ ': O <br /> all Information contained in this application(Including any accompanying schedule)and I further declare that I ree 39nize PM o <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whothe r to Is- E S E $ <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Informatic n 1 am p <br /> providing In this application. I agree to permit county officials charged with administering county ordinances o other . <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspq ction. c H <br /> m <br /> 73 N <br /> SIGN HER Are ^ �� ' '• N <br /> no f owner or building contractor) ( I _ (date) f` O <br /> 1 is : o : <br /> ZONING ADMINISTRATOR 1 ! ! W2011% <br /> c E <br /> �I NN0PO T <br /> TOWNSHIP PERMITS MAY BE REQUIRED $ $ S $S S $ tmo <br />