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NCtYT ) <br /> � Z <br /> Burnett Coynty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator _ -( <br /> (1 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> z <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the workti <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 - o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> OWNER TELEPHONECD <br /> v <br /> HOME ADDRESS /d-7 <br /> I A <br /> EMERGENCY/FIRE NUMBER p o ROAD NAME 1� �t <br /> Q C� <br /> LEGAL DESCRIPTION(see tax receipt) <br /> � �' <br /> CONTRACTOR �� 4 dt /'1� <br /> o A <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE-VX—ADDITION— 0 <br /> tl 0 <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> ]� <br /> o 1 <br /> STRUCTURE/ADDITION USE: b eif <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. In <br /> O t" <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 <br /> a Cn <br /> 1. All required dimensions or distances to be shown or drawn to scale. n o Cr <br /> 2. Show the location and size of all existing buildings(EB) and all new buildings(NB)and indicate m y: <br /> North (N). N (/j ° <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. C� <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. U <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. O Cn <br /> 8 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. C, <br /> CONDITIONS OF PERMIT: v, <br /> H <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 0 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 /> 7. �ee /-x�� ie/'Ai o �;v C D C <br /> < H .2yQ CD CD <br /> om <br /> 8. C <br /> ICA <br /> c <br /> o : CL C <br /> CD CD <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my ` L7 <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of �„'w d' m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> oii o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- $ : c <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 o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other8 ' <br /> authorize on to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> SIGN HERE ` �+l�_ , ,. •c:I 1 y f� ! H i i i <br /> o i i <br /> n reef owner orbuilding contractor) (date) o ; <br /> ZONING A IST <br /> Y } Jim 2 0i <br /> !1 .• � � �N NU1NNNflT <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />