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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator d 0 0 <br /> APPLICATION FOR LAND USE PERMITS3' o <br /> u <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work y <br /> described and located as shown herein. The undersigned agrees that all work shall be done in a cor- 3 <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all ther o Vr <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> o <br /> OWNER t �tJ © TELEPHONE <br /> 0 1 m <br /> HOME ADDRESS <br /> w � <br /> EMERGENCY/FIRE NUMBER' ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CONTRACTOR <br /> 'm O <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ARAG CCESSORY STRUCTURE�ADDITION <br /> r <br /> m O <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION v <br /> Z <br /> m <br /> STRUCTURE/ADDITION USE: e <br /> (Home/Cabin; Commercial Bu nese; Bedroom;Deck;etc.) <br /> r <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE O <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> O v N <br /> 'n Z a <br /> 1. All required dimensions or distances to be shown or drawn to scale. a <br /> m o <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB) and indicateC o' <br /> North (N). <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 riv r. <br /> 4. Show the location of the well (W), septic tank (ST) and drainfield (DF), and all distances to buildings, W <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 <br /> signed and dated by the owner. cn <br /> � I 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE <br /> -FORE A PERMIT CAN BE ISSUED. N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. VN�1 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMI 2 <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 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 /> z °C< > > � $ m <br /> 7. n 9 � m Cy M <br /> ? Wo 1 <br /> Z f T J1 <br /> 8. ° i1 m <br /> of m D <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the bei t of my m <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and acc iracy of <br /> om o : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I re ognize b m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining wheth r 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 informal on I am n E <br /> providing in this application. I agree to permit county officials charged with administering county ordinances r other <br /> authorized person ve access to the above described premises at any reasonable time for the purpose of insl lection. <br /> m B <br /> Qom[^ m <br /> SIGN HERE <br /> 1 <br /> (agnatu o neror building contractor) (data) o <br /> o : <br /> - o <br /> ZONING ADMINISTRATOR `✓I, E i <br /> N -n <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 ' PM <br /> Coco0 oN <br />