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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Offic of Zoning Administrator m o <br /> APPLICATION FOR LAND USE PER ITS '- 3. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes applicati n for a Permit for the work � <br /> H <br /> described and located as shown herein. The undersigned agrees that all rk shall be done in actor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanit tion Code,and with all other <br /> applicable County Ordinances and the laws and regulations of the State of sconsin. <br /> OWNER (/LCA v TELEPHONE (^" <br /> HOME ADDRESS W l Q 1-y p )xer FeI/S W, S7 oo-z- <br /> EMERGENCY/FIRE <br /> EMERGENCY/FIRE NUMBER 3 00?0 ROAD NAME ,f4/ 1) <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CONTRACTOR >S �+ <br /> 0 <br /> c <br /> TYPE OF PERMIT(S): DWELLINGBUILDING_X GARAGE/ACCESSORY STRUCTURE ADDITION � -�.- <br /> N <br /> O <br /> SANITARY X PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION <br /> l� I_�I/ Z <br /> STRUCTURE/ADDITION USE: W 1 ` <br /> ome/C ' , ommercial Business; Bedroom;Dedc;elt.) v <br /> r <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE 014o <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> In <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) A <br /> O <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 buildin s (NB)and indicate m H' <br /> North (N). C <br /> N <br /> 3. Show dimensions in feet of the following: (a) buildings) to all lot lines, (b) uilding(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 ill distances to buildings, <br /> roads, lake, lot lines. <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or f lied. Lf` <br /> 6. If separate plans are submitted by an architect, engineer, builder, contracto , etc., the plans must be y <br /> signed and dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSI E VERIFICATION BE- Q ; <br /> FORE A PERMIT CAN BE ISSUED. v �, <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. FNS <br /> CONDITIONS OF PERMIT: a <br /> W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 0 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 z <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE <br /> 5. OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. (� <br /> f <br /> 6. <br /> o co -0 W > v <br /> 8. z F : [ Tco: x <br /> ` ? cit : m <br /> 'm A <br /> � [ <br /> Si C <br /> o m i'o <br /> I declare that this application (including any accompanying schedule) has been examine I by me and to the best of my ZS. � <br /> knowledge and belief It is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of p <br /> all Information contained in this application(including any accompanying schedule)and I lurther declare that I recognize o F o : <br /> o , o : <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whetherto is- 0 : o <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett n lying on this Information I am O p': <br /> providing in this application. I agree to permit county officials charged with administerlir g county ordinances or other i 3 8 <br /> authorized person to have access to the above described premises at any reasonable time or the purpose of inspection. m i : '� : v+ <br /> m <br /> � B <br /> SIGN HERE <br /> w <br /> (aignatureof owns or bul Ing c r) <br /> at <br /> 00 <br /> i f E <br /> ZONING ADMINISTRATOR <br /> o <br /> : <br /> T NSHIP PERMITS MAY BE REQUIRED m <br /> O u N O N U N O <br /> ��$ 000000rmA <br />