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(9✓) a�lp/ <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator d -11 ; o <br /> APPLICATION FOR LAND USE PERMITS d 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work zv 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 County Ordinances and the laws and regulations of the State of Wisconsin. jj <br /> OWNER TELEPHONE ^p <br /> HOME ADDRESS a2 y d& &&K t O k ow.), <br /> EMERGENCY/FIRE NUMBER ROAD NAME L <br /> rZ.U4?,P <br /> LEGAL DESCRIPTION(see tax receipt) �1 3f <br /> CONTRACTOR N_ <br /> m G) <br /> TYPE OF PERMIT(S):DWELLING/BUILDINGA_GARAGE/ACCESSORY STRUCTURE ADDITION <br /> ' r <br /> N O <br /> O � <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> — <br /> Z 0 <br /> m <br /> STRUCTURE/ADDITION USE: NOILrP_ <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. O �. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: Aerial or to A <br /> ( P view) O 3 <br /> m 'P � Cn <br /> m o a <br /> 1. All required dimensions or distances to be shown or drawn to scale. n <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB)and indicate M Q3 o <br /> North (N). m 1 ' <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. 2. <br /> (� <br /> o Xl <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <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. <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 /> M o c -. m <br /> 7. R d C0007 3 <br /> N O ? 0 0 50 <br /> Z y: .M <br /> 8. P �— m <br /> cn : G>� D <br /> C <br /> w m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ' E ; m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of i „'@ O <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizem <br /> 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 /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Information I am p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 iQ <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m m <br /> SIGN HERE <br /> N <br /> (signature o owner or building contractor) (date) o <br /> ++ o : <br /> ZONING ADMINISTRATOR I fYl FI� <br /> N N N N N N G n m <br /> TOWNSHIP PERMITS MAY BE REQUIRED po 0 0 0 0 0 o m <br /> OO 000000 rA <br />