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&4 coxy, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator C 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit forte work DC4 <br /> described and located as shown herein. The undersigned agrees that all work shall be done ir actor- `= � <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with ll other 3' <br /> o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. N m <br /> c <br /> OWNER <br /> b l- f- . LSA _ TELEPHONE - g, a M <br /> o <br /> _ <br /> m <br /> HOME ADDRESS ty <br /> 40" , <br /> OL <br /> EMERGENCY/FIRE NUMBER / C ROAD NAME 7 s- -f-t g-� J Y n <br /> LEGAL DESCRIPTION (see tax receipt) .�� C'SnV. 5 <br /> CONTRACTOR <br /> 0 o ') <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION 0 - <br /> N 0 <br /> O <br /> SANITARY4 <br /> � P AR��IVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITIO <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <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. -n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> T 3 n <br /> T o n <br /> 1. All required dimensions or distances to be shown or drawn to scale. <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate m =: <br /> North (N). w ° <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) buildinto centerline of m <br /> gs) <br /> road, (c) building(s) measurement to the ordinary high water mark (OHWM) of lake, stream or river. s <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildings, so <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 mu t be s <br /> signed and dated by the owner. <br /> GO <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION E- ° <br /> FORE A PERMIT CAN BE ISSUED. 0 <br /> \, <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERM T s <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. (��v <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY p <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. DECK OR ANY PORTION OF THE BUILDING ADDITION IS TO BE 40 FEET OR <br /> GREATER FROM THE REAR LOT LINE. <br /> ym T (n rD DO 'o <br /> 7. $gym � n ?. nm °amm <br /> o c <br /> P— y o S M <br /> U5 Z! W O ,O 3 <br /> EP N P-428. UUP <br /> 0 <br /> d i N': i � c i ? D <br /> 0 m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the bet of my ` G In <br /> knowledge and belief It is true, correct and complete. I acknowledge that I am responsible for the detail and acc uracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I n cognize ` c m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whet or to Is- 0 : <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this informal on 1 am O <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> 3 i <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of ins action. m i i i v <br /> m <br /> SIGN HERE <br /> N : <br /> Isla ure of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR 0 <br /> " "s wFn E»o m <br /> N N U� N N N f n <br /> TOWNSHIP PERMITS MAY BE REQUIRED � � o : : b : m <br /> 0 0 0 0 0 0 0 0 <br /> 00000000Cn <br />