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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 <br /> Office of Zoning Administrator N v -+ z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work <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 w <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y d <br /> OWNER ^- t j p� � etSC TELEPHONE <br /> `xW W / A 1f qttl <br /> HOME ADDRESSi l U 2I 4LLeLee. A 0 w C hCu pl <br /> `Y �H f'C"Z/�' <br /> EMERGENCY/FIRE NUMBER ;! i <br /> 7 ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) ` J_ U L. s 14,1 <br /> ,2 S« a4' (Doo,y L.a 4 4 SFe•(y, 131 17�— <br /> CONTRACTOR <br /> 0 ��4 C N4 /- - <br /> rVLYP Lh.in.4X¢r �t K7l S�/Q;J <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ADDITION <br /> GARAGE/ACCESSORY STRUCTURE V ° (Q <br /> y <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT <br /> SUBDIVISION v <br /> STRUCTURE/ADDITION USE: Ilv P <br /> ------------ <br /> (Home/Cabin; C mmercial Business; Bedroom; Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> T <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O <br /> O v <br /> 1. All required dimensions or distances to be shown or drawn to scale. r Z Q03 <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB) and indicate O ° n <br /> North (N). to ° I <br /> 3. Show dimensions in feet of the following: (a) buildings)to all lot lines, (b) buildings)to centerline of <br /> road, (c) buildings) measurement to the ordinary high water mark (OHWM) of lake, stream or river. m ' <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildings, Q� <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. d U� <br /> Cn <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- 0 <br /> FORE A PERMIT CAN BE ISSUED. o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Imo, <br /> CONDITIONS OF PERA4IT: 4-- <br /> v I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. I� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ��� Z <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 FEET OF THE ( n <br /> 5. huOHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 6. 6Ajtr S/z/ 90 -hKa -7. <br /> F <br /> S �(� '7/QirCl - R $f m <br /> e t" LG/en 7Jg4 Rao Ram <br /> 8. C+ R Q2 err/5Y7 moo : � mo �m3 <br /> S C f TN , <br /> m <br /> I <br /> are that this application (including any accompanying schedule) has been examined by me and to the best of m J n c i : C <br /> o :` ° � <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am resccu y m' :` m <br /> all Information contained In this application(including any accompanying schedule) I further declare thatl recracyognizof <br /> e <br /> that this Information I ac providing will be icled upon by the County of Burnett Wisconsin in determining whether to is. <br /> o o <br /> Pi <br /> sue i permit. I further accept all liability which may be a result of the County of Burnett retying on this Information I am <br /> providing In this application. I agree to permit county officials ehargetl with administering county ordinances or other O• v' <br /> authorized person to ve access to the ove described premises at any reasonable time for the purpose of inspection. v E x <br /> SIGN HERE �_ r-- <br /> (signature owner orb it g co ctor) N E <br /> IJ;j (dab) i o i i <br /> ZONING ADMINISTRATOR g i; <br /> TOWNSHIP PERMITS MAY BE REQUIREDI U11 lio N m o N N i m <br /> 00000000m <br /> - � i o0000000N <br />