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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v3( /o <br /> APPLICATION FOR LAND USE PERMITS <br /> { � o <br /> TO THE•ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit forth1work <br /> described and located as shown herein. The undersigned agrees that all work shall be done in ccor- 3 <g <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. <br /> OWNER L Y x�� ;� f"i. ���j ix ,/ j Sx_ TELEPHON���L� UE Z-79 H o <br /> m <br /> HOME ADDRESS �o 10 LAJIF (_5 <br /> EMERGENCY/FIRE NUMBER ROAD NAME n C", <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CONTRACTOR -5 C <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> y r <br /> 0 <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION <br /> - <br /> 0 0 <br /> STRUCTURE/ADDITION USE: -iVC-k afBQN <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. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) A <br /> O a 3 <br /> m P N <br /> T Z c <br /> 1. All required dimensions or distances to be shown or drawn to scale. n P a <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB) and indicate m <br /> North (N). (a <br /> N <br /> 3. Show dimensions in feet of the following: (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 rh er. <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildi gs, <br /> roads, lake, lot lines. <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. I <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 /> 1 � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATIONBE- <br /> FORE A PERMIT CAN BE ISSUED. € N rt <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. J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELI E. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Z <br /> PERMITTED. 9 <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 /> 7. l S� a� 5 <br /> 12 CO ee pl P_'2 <br /> : =f <br /> Z F _1 c : : M <br /> 8. O <br /> ot G= c <br /> o <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the be t of my ! m <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and acc racy of G <br /> all information contained In this application(including any accompanying schedule)and I further declare that I cognize ` m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whet er to Is- $ <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Informal on I a o E <br /> providing in this application. I agree to permit county officials charged with administering county ordinances r other <br /> authorized person t ave access to the above described premises at any reasonable time for the purpose of Ins pection. <br /> SIGN HERE �� f l' <br /> sl a re of ow er r building contractor) (date) <br /> o i <br /> n o ; <br /> ZONING ADMINISTRATOR <br /> m <br /> ra <br /> " <br /> �Fnwwtnom <br /> O U f (P o f P P f P o m <br /> N N N N N N t l l m <br /> TOWNSHIP PERMITS MAY BE REQUIRED f SSSS $ $S $ to <br />