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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator c' -. 0 <br /> APPLICATION FOR LAND USE PERMITS — <br /> Q s <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work m <br /> described and located as shown herein. The undersigned agrees that all work shall be done in accor- <br /> 2 CD <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. m <br /> OWNER Ckk� t'.f /��.rr afr'.•tn TELEPHONE 4/_3f , Y77 ^p <br /> /L /HOME ADDRESS kr4A VlCLSh" ka J—y e uN <br /> EMERGENCY/FIRE NUMBER 3 / Yb ROAD NAME 'k '/f- r.o M <br /> LEGAL DESCRIPTION(see tax receipt) Skf 1Vf M f ow /tf "" <br /> CONTRACTOR t <br /> ( o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION 0 <br /> N w <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o $ <br /> STRUCTURE/ADDITION USE: o r <br /> (Home/C804;Commercial Business; Bedroom; Deck;etc.) <br /> r <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. T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> -n P vi <br /> '11 o a <br /> 1. All required dimensions or distances to be shown or drawn to scale. n <br /> FL <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB)and indicate m 9J o <br /> North (N). w ' <br /> 3. 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. x <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. <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 l <br /> signed and dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <br /> 5. <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. <br /> 9 s FL $ <br /> 7. a mK pCyoJ9 <br /> f 7 TZ <br /> O m <br /> 8 . <br /> 1 declare that this application (Including any accompanying schedule) has been examined by me and to the best of my m <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of 6 <br /> all Information contained In this application(Including any accompanying schedule)and I further declare that I recognlz E o o <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is. <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 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. ,n <br /> IB i <br /> SIGN HERE <br /> (sig1joture of owner or building contractor) (data) $ [ <br /> ZONING ADMINISTRATOR : (q(q ' '• <br /> ' ««tn NNNN T <br /> TOWNSHIP PERMITS MAY BE REQUIRED o o o o rn <br /> o $ o $ oo $ $ fA <br />