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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -+ Z <br /> + APPLICATION FOR LAND USE PERMITSEr 3 ° <br /> TO'THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work Q <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. H m <br /> OWNER &Ileen <br /> ry) .....A <br /> TELEPHONE L/ou,a-9 7(o w o0i 1D <br /> HOMEADDRESS /9�116 6ran: ur <br /> bL4 I(,()]- SgPY6 v � <br /> EMERGENCY/FIRE NUMBER j `1 t{�� ROAD NAME /�_ \� _7 /�RJ <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CONTRACTOR �erSQn <br /> v 7 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> 0 <br /> yy1 �o <br /> STRUCTURE/ADDITION USE: !r 1 U d Root 1 br CLOIE Rnnrn <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <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 /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) X <br /> mp Cn <br /> 1. All required dimensions or distances to be shown or drawn to scale. n o a <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB)and indicate m y <br /> North (N). c 0 <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. <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. 0 <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 /> Cn <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. ` <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. X� <br /> CONDITIONS OF PERMIT: v <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 SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Z <br /> PERMITTED. :b <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 /> 6. <br /> fn(A -ofn rOy > y <br /> 7. D LC 0.1 P a m i <br /> m m5.: °ic80 <br /> O 7 M <br /> CD <br /> 8. c fes : Wim: .D <br /> G�2 i m <br /> � i G_ <br /> o i m m; <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 accuracy of WOO ` pall information contained in this application(including any accompanying schedule)and I further declare that I recognizethat this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- 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 n? p' <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 2 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. TD '• w <br /> m <br /> SIGN HERE n <br /> (sign ro f owner or Ing cotp <br /> n <br /> t <br /> ZONING ADMINISTRATOR <br /> 2 ia'±ift wit -n <br /> oNcNiocNi�tNn ,CAom <br /> TOWNSHIP PERMIT i MA BE REQUIRED w_ 0 0 0 . o m <br />