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ctm p I <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator rn -0o 0 <br /> APPLICATION FOR LAND USE PER ITS . <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes applicati n for a Permit for the work s <br /> described and located as shown herein. The undersigned agrees that all rk shall be done in actor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,San! tion Code,and with all other <br /> applicable County Ordinances and the laws and regulations of the State ofisconsin. <br /> OWNER e 0 �/�l�Y� �( SO /t, TELEPHONE -76 !L'�, o v <br /> HOME ADDRESS //��� y✓ IA e <br /> �6 ss /-,9-,�e%�y VVVyy V V V �j-1rs I <br /> EMERGENCY/FIRE NUMBER ROAD NAME Pc� ' t <br /> LEGAL DESCRIPTION(see tax receipt) 02 S T y 61 <br /> CONTRACTOR p F l OIVE�t-o Ef ov o <br /> 4 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o" <br /> y r <br /> tz <br /> 0 <br /> SANITARY PRIVYFILLINGGG/`GRAADIIING1 CAMPING UNIT SUBDIVISION- <br /> Z <br /> STRUCTURE/ADDITION USE: �J 1 '1_ J I V I L[ V l o v <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;a .) <br /> r <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) z <br /> T3 cn <br /> 1. All required dimensions or distances to be shown or drawn to scale. 0 o g <br /> 2. Show the location and size of all existing buildings (EB) and all new buildinPs(NB)and indicate m H: <br /> North (N). C <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) uilding(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, <br /> roads, lake, lot lines. v l <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or�r, <br /> illed. <br /> 6. If separate plans are submitted by an architect, engineer, builder, contract etc., the plans must be <br /> signed and dated by the owner. _ ti <br /> I B <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSIE VERIFICATION BE- a <br /> FORE A PERMIT CAN BE ISSUED. 90 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. U) <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 130 DAYS OF PERMIT <br /> ISSUANCE. d <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. v <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ? <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWEDTHIN 75 FEET OF THE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTE I <br /> 5. <br /> i F <br /> 6. <br /> 7. <br /> s g'C _ m <br /> m� °i CYn .0 <br /> 0 <br /> ti <br /> m <br /> of iu � D <br /> I declare that this application (including any accompanying schedule) has been examinby me and to the best of my ' m: m <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsibl for the detail and accuracy of <br /> all Information contained in this application(Including any accompanying schedule)and I urther declare that I recognize E PM o : <br /> o , o ; <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsll+ in determining whether to Is <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett lying on this Information I am O o <br /> providing in this application. I agree to permit county officials charged with administers g county ordinances or other 3 8 <br /> authorized person to h ve access to the above desc Ibed premises at any reasonable time for the purpose of inspection. m m <br /> SIGN HERE a-h'� —( -- �L, N i <br /> (sl alu of ownero b n contractor) (Cele) $ i i <br /> ZONING ADMINISTRATOR <br /> "non 0M <br /> TOWNSHIP PERMITS MAY BE REQUIRED P v, o u, u, u, o m <br />