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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator d o 0 <br /> APPLICATION FOR LAND USE PERMITS d 3. <br /> z <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work � y <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor. 3 <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other - o <br /> applicable <br /> ///,County Ordinances and the laws and regull+ationss of the State of Wisconsin. 6 p H ?: <br /> OWNER/1 (Jl�� �L����T� ��J O/1� TELEPHONE7IS�'3_5, _ o <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER"/ �70NlN6_ b(97_ ROAD NAME � n' <br /> // -- ? T // �` ' <br /> LEGAL DESCRIPTION(see tax receipt)c0 V T Zee � Sec 3& / 35/N le 16 ke <br /> CONTRACTOR 7D40 Al a-r • y�� <br /> 0 <br /> ° m <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION 0 �- <br /> N O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION- <br /> STRUCTURE/ADDITION <br /> UBDIVISION STRUCTURE/ADDITION USE: <br /> (Home/Cabin;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. n <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 <br /> T P m <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 mo <br /> North (N). m <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. <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. -I <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 <br /> signed and dated by the owner. ( I v <br /> 'T 8 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> o W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. UI <br /> CONDITIONS OF PERMIT: o <br /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT s � <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. <br /> l <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 Previous camping permit #rs: 18348, 17503, 16862 h 16157 <br /> m(nvmrDDoy <br /> o Cm no. f <br /> rn <br /> G N. : Z O O(O r <br /> N O 0 0 <br /> N i E C ' m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my O' <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of ` d'm d' m <br /> 9 P 9 P Y � u+ in rn ; 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 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 0: p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other E 3 2 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. 1m ? ? N <br /> SIGN HERE t <br /> (signature wnerorbulldin . *rt- L, ) ydata)- O : <br /> o : <br /> ZONING ADMINISTRATOR M iAAn <br /> ° <br /> N N T N N N U <br /> M <br /> TOWNSHIP PERMITS�!MAY BE REQUIRED <br /> L 0 0 0 0 0 0 0 0 <br />