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00 coy / <br /> Burnett CUunty 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator Iu ; o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work <br /> described and located as shown herein. The undersigned agrees that all work shall be done in accor- fD g <br /> 3 <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other <br /> v <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y °' <br /> � v <br /> OWNERM'dVQ j j- cp_ rn b TELEPHONE L��A %,3,q(139 d <br /> HOME ADDRESS 1539a 2cd4bCD <br /> C 54 , ML FornfL le-e /Y)n �oZ5 � 1 <br /> /� _ <br /> EMERGENCY/FIRE NUMBER �VaNcc ROAD NAME (yr r J V/CW I)r'; ( '1 <br /> LEGAL DESCRIPTION(see tax receipt) L,c--f ID/ C SM I y O L 7 I h ffp� 15 L7 a/71- /6O <br /> CONTRACTOR �I 4 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ° <br /> y � <br /> 0 <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> Z ° <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <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. 0 <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) T B <br /> T O c <br /> 1. All required dimensions or distances to be shown or drawn to scale. m < <br /> 2. Show the location and size of all existing buildings(EB)and all new buildings(NB) and indicate M <br /> a. <br /> North (N). m <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of I <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. 01 <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. <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be 0 <br /> signed and dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- a <br /> FORE A PERMIT CAN BE ISSUED. <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W <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 ` <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 /> oc �g2m, 8a* m <br /> 7. � wcrno � 70 <br /> 00). <br /> N ° 7�° <br /> EThi <br /> =m: M <br /> 8. 0 62i A <br /> M <br /> C <br /> o : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my y m <br /> knowledge and belief It is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> oroo ; <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o m o <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- E 0 . o : <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Information 1 am O o <br /> providing in this application. I agree to permit county officials charged with admini in afher 3 <br /> authorized person to have access to the above described premises at any reasod d� y <br /> T <br /> y <br /> SIGN HERE y ^' <br /> (sign atu of r contractor) FEB <br /> 8i <br /> ZONING ADMINISTRATOR — Eift <br /> omBUR _MmN�o0(nm <br /> OWNSHIP PERMITS MAY BE REQUIRED ZONING �o00000$ o0 ooffnA <br />