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0a co}> ) <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o O <br /> APPLICATION FOR LAND USE PERMITS d 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for thez work � <br /> described and located as shown herein. The undersigned agrees that all work shall be done in i ccor- 3 <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. y m <br /> 1 <br /> OWNER !��-`���- \ p la) TELEPHONE <br /> 1, 1.� VV v v v <br /> HOMEADDRESS RRIr <br /> EMERGENCY/FIRE NUMBER ROAD NAME ^ Rd. 1 I� Cu <br /> / 1I <br /> LEGAL DESCRIPTION (see tax receipt) S l'/ 4-L- v \ � <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION <br /> N y <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONv <br /> 0 5 <br /> 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 O <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n <br /> O <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> m P N <br /> T o <br /> 1. All required dimensions or distances to be shown or drawn to scale. or <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 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 /> uildin s, <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 <br /> signed and dated by the owner. <br /> R <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION B - ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> o R <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> vi <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 SHORELIN . <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 OFT E <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> F <br /> 6. <br /> o c s m> D O 17 <br /> 7. m ' a,� P'-. am $my <br /> �°• mo0m' 3 <br /> 8. <br /> N Vic : m <br /> O <br /> o_ ii5 C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accu cy of p <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o 0 0 <br /> 1D o <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- <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 1 O p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m m <br /> la N <br /> H <br /> SIGN HERE : ' � <br /> N ; <br /> (signature of owner or building contractor) (date) o <br /> o i i <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 <br /> N N tit N N N V m <br /> 00000000 f// <br />