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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ( 0 0 <br /> APPLICATION FOR LAND USE PERMITS2. <br /> s <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work m <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 /> v <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> OWNER ocj¢ E Com PTO) l TELEPHONE G3� _ ��/�c-i 0 <br /> HOME ADDRESS .BIZ. �tJ / O v <br /> T s rL�Hc r1 FA, , eld ALL- • �"L 70 <br /> 4' r <br /> EMERGENCY/FIRE NUMBER ROAD NAME 4 <br /> LEGAL DESCRIPTION(see tax receipt) ��o/r?t4+N/ 2a�/-z2o �+ Kc—f,LI''�s�6- 'b'37Do is <br /> y++ ;��, ��.cz,`£•„hl 993 46� <br /> CONTRACTOR ����,-. E �✓��I fJPJ � q <br /> I O <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION 0 <br /> N O <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o � <br /> STRUCTURE/ADDITION USE: 1 Je G IC QDIGI.e l/(r'Lltrr a o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> r <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. nl <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> T P cta <br /> T Z <br /> 1. All required dimensions or distances to be shown or drawn to scale. n o <br /> � - <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate m y <br /> North (N). w <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. O <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. J in <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- (7 <br /> FORE A PERMIT CAN BE ISSUED. <br /> N <br /> 0 <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE <br /> 5. OHWA OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 6. <br /> Dc n7 <br /> M g_c �.� � � aEm <br /> 7. m R,* <br /> o 0c ; <br /> Z F T rn <br /> 8. P in cc : <br /> cm <br /> A <br /> C <br /> o <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my m m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- o o <br /> o : 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 ': <br /> authorized person to ha ess to the escr misea at any reasonable time for the purpose of Inspection. <br /> SIGN HERE <br /> (sig tur of owner or Ing contractor) ( ) o <br /> o <br /> ZONING ADMINISTRATOR <br /> Fn FN n N:M eN 'n <br /> fJi N N <br /> TOWNSHIP PERMITS MAY BE REQUIRED o un m o u u, u, N o m <br /> ogg00000 V) <br />