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N cow <br /> BurK&County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Adminis rator m m o 0 <br /> APPLICATION FOR LAND USE PERMITS d 3. <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 inaccor- <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 C���f Cj-t 1 TELEPHONE <br /> W �z, 8�� �I �° <br /> HOME ADDRESS ) _' I�f� T Ef- 3 S Inlet s , <br /> EMERGENCY/FIRE NUMBER ROAD NAMEt7TC .(J1. J <br /> LEGAL DESCRIPTION(see tax receipt) Sw - 3 . L/V— <br /> CONTRACTOR u� <br /> 0 <br /> m O <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE—ADDITION—_X0 Cp <br /> o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> - <br /> z <br /> 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 C R <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> "n ? y <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 In N <br /> SU <br /> North (N). w <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) building(s)to canted in of m <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM) of lake, stream or river. r <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildings, y� <br /> roads, lake, lot lines. <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. Cj <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be ) 10 <br /> signed and dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. <br /> N <br /> 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <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 p 9 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF HE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> 6. �; (� <br /> s 2nE m <br /> R <br /> 7. Z N O '2 <br /> Z f J ZU!p <br /> a. 3 <br /> u : 252 m <br /> o : m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the bes of my 0 . ?gym <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I nic ognize o m ; <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether 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 informatl n I am O o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 ; <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. m ? a <br /> N <br /> SIGN HEREvKJrI-G-+ <br /> (signatureof ownw1rr buildingetnctor) (date) <br /> o : <br /> ZONING ADMINISTRATOR <br /> N N f T N N N (n m <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 0 rn <br /> 00000000 rA <br />