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(977 4� , <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Adminis rator d - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 0 -' <br /> 00 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work <br /> described and located as shown herein. The undersigned agrees that all work shall be done in ccor- m <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other 3 0 9-) <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> O <br /> OWNER G ��i7]�� TELEPHONE 715 K <br /> HOME ADDRESS6-2-57 6:VLL LA rll; D� 24 ilJ�L,/l IV( / d VI <br /> EMERGENCY/FIRE NUMBER C� 2 S- ROAD NAME ULL 1.AlC4A2 <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION <br /> r <br /> y C <br /> O V <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION _ <br /> Z $ <br /> STRUCTURE/ADDITION USE: �7dM (, ��c— �� l o/a "' (✓`/� a`bL <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 R <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 <br /> m Z c <br /> 1. All required dimensions or distances to be shown or drawn to scale. ° a <br /> 2. Show the location and size of all existing buildings(EB) and all new buildings(NB) and indicate �1j o <br /> North (N). W <br /> 3. Show dimensions in feet of the fallowing: (a) building(s) to all lot lines, (b) building(s)to centerlir e 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 buildi igs, W <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 mut be r <br /> signed and dated by the owner. co <br /> N <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION E- 1-j <br /> 1 <br /> FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <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 SHORELI 4E. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Z <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 /> f <br /> 6. <br /> D DOS <br /> Rao M <br /> 9 N O Z <br /> m <br /> 8. ` N[ m <br /> A <br /> of nom ; C <br /> o ` m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the bet of my <br /> `0 I. E m <br /> d ; <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and ac racy of v, y N C <br /> o D o : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I cognize o m o <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whotl or to Is ' o : 0 : <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this informs ion I am O o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 i4 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of ins ection. <br /> m i a i i <br /> m <br /> P2 « <br /> SIGN HERE « <br /> (sig tur of owner or build ntractor) (date) <br /> ZONING ADMINISTRATOR <br /> 0�9 N N f n n- <br /> N« m <br /> O N N O V N U <br /> m <br /> TOWNSHIP PERMITS MAY BE REQUIRED .0 0 0 0 C, <br /> 000000 o <br /> 0 <br />