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. " ' J) ) <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator d - 0 0 <br /> APPLICATION FOR LAND USE PERMITS ) <br /> w o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for thi work <br /> described and located as shown herein. The undersigned agrees that all work shall be done in ccor- g 00 <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with al other o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. m <br /> OWNER TELEPHONE <br /> CT:�y <br /> HOME ADDRESS51-„ N <br /> I „ Br ) r, 13rooKI ( L <br /> ` m <br /> 1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> Br ba S � r r <br /> LEGAL DESCRIPTION(see tax receipt) 3 / `/O/V I 1/ <br /> CONTRACTOR r %: <br /> g <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION C� <br /> N O <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION :? <br /> Z 'o <br /> STRUCTURE/ADDITION USE: V r � � 1 53 � <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> CT <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. m0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 <br /> -n 'P n <br /> '" o g <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 Q, <br /> North (N). w �00 <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerli a of m I <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 build!iigs, C. <br /> roads, lake, lot lines. l 1 <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. 0 a <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans mul t be <br /> signed and dated by the owner. rn <br /> G' 2 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION E- <br /> FORE A PERMIT CAN BE ISSUED. <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 PERM <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELI E. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 1 9 <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 /> F <br /> 6. <br /> wmvw� > OM <br /> 4. a MS a 3 m <br /> 7. �� -' am » ! M <br /> A N Z : d C fn 5' 5' <br /> 'F TZ M <br /> t1 <br /> 8. O m <br /> of 0a C <br /> o : M <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the b t of my <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and ac racy of N y D <br /> oa o ; <br /> all information contained In this application(Including any accompanying schedule)and I further declare that 1 r cognize E o m o <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whet or to Is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Informs on I am o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances 5r other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Ins Pection. m ? `E <br /> B <br /> N i to f <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) S <br /> ZONING ADMINISTRATOR ) vIE <br /> "N NUNNN N N m <br /> � <br /> TOWNSHIP PERMITS MAY BE REQUIRED o N o o `n o 0 o In <br /> gSo $ S000N <br />