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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator w - 0 0 <br /> APPLICATION FOR LAND USE PERMITS - <br /> 0 <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 inaccor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other 3. <br /> 0 <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y <br /> OWNER / , TELEPHONE 6 /2 <br /> HOME ADDRESSSS 5' Z- <br /> lo 1(2 � C_ Tl- c: T , S � /w� =rmv <br /> EMERGENCY/FIRE NUMBER !1 ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) �CI , /.��J / ) cTT <br /> CONTRACTOR t /� o <br /> Q o n <br /> TYPE OF PERMIT(S): DWELLING/BUILDING�GARAGE/ACCESSORY STRUCTURE—ADDITION- <br /> 0 <br /> TRUCTURE ADDITION <br /> N <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION— <br /> STRUCTURE/ADDITION <br /> UBDIVISION STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> r <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 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> T 7 in <br /> T Z <br /> 1. All required dimensions or distances to be shown or drawn to scale. n P <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB)and indicate m y' <br /> North (N). U)) <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerlin of m I <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 buildir gs, U <br /> roads, lake, lot lines. <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. n <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans musi be i <br /> signed and dated by the owner. y <br /> ig <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION B - ° <br /> FORE A PERMIT CAN BE ISSUED. 2. — <br /> o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> H <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMI <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 l p <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF I HE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTE,D. / <br /> 5. of b ex G.6a7t7o�v o^, slop,'S D.P-0!o T vrn�r ;e <br /> 6. -2 V rposc'o4 Se Xcu ua 40d R Pfas , Le Seed - /nu <br /> #.� I , J,^-� - <br /> maM0S DFrn <br /> 7. / 101 oc � Ram $ m <br /> ' O•�, �U�-°... S! f'G ° 370 <br /> �m 3 <br /> 8. o Fes : fur: M <br /> / m <br /> �.alxjffod <br /> o mmi ' M <br /> I declare that this application (Including an# accompanying sc duls) has been examined by me and to the bes of my ; m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accu acy of f„y i`„I a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I re gnlze ` m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining wheth 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 Informati n I am n 0: <br /> providing In this application. I agree to permit county offlc#ys cha ed ith administering county ordinances other 3 <br /> authorized person to have access to the above described p9"Ise asonable time for the purpose of insp ction. T ! y <br /> SIGN HERE (I °p N <br /> ( n ure of own o ullding eontraetor) <br /> ZONING ADMINISTRATOR � <br /> TOWNSHIP PERMITS MAY BE REQUIR � N N N N N N N <br /> 1J l : O n n 0 V N N O m <br /> A t� ,I 00000000 U) <br /> (�IT 'nT C,- 1a -6�� � <br />