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O(L Carp I <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator d ' Z 0 <br /> APPLICATION FOR LAND USE PERMITS d 3. <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 in accor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> OWNERj��� �� TELEPHONE LO//Z/J ,,� ^c' m <br /> HOME ADDRESS �� / 73 7 317 ( � <br /> �e <br /> EMERGENCY/FIRE NUMBER U /_ ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) L7 /rizC / A, <br /> CONTRACTOR �d! <br /> !/tel o <br /> � o <br /> TYPE OF PERMIT(S): DWELLING/ UILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> N i <br /> O <br /> SANITARY PRIVY FILL�IN/G/GRADING CAMPING UNI � SUBDIVIISSIION �. o <br /> STRUCTURE/ADDITION USE: -/ / Zree C Y G vI{�K13 <br /> (Home/Cabin; Commercial Business; So oom •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. r <br /> O <br /> M 2 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> m p <br /> T Z <br /> 1. All required dimensions or distances to be shown or drawn to scale. cf ° <br /> 2. Show the location and size of all existing buildings(EB) and all new buildings(NB)and indicate m <br /> North (N). m 9J ' <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of <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. <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 d x <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 /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. m `� <br /> CONDITIONS OF PERMIT: <br /> n <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT r <br /> ISSUANCE. Y- <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Zb <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY mb <br /> TNS ? <br /> PERMITTED. () ) <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE f <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> 6. <br /> M bnm�<n� A', gym <br /> 7. m Ctnno =' i <br /> 9 <br /> M <br /> 8. ° [ c 2 m <br /> o : nom : C <br /> 1 declare that this application (Including any accompanying schedule) has been examined by me and to the best of my m : m <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of _ E �„m �;? C <br /> oa o : <br /> all Information contained In this application(Including any accompanying schedule)and I further declare that I recognize <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 0: o : <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 : 8 <br /> authorized person to hV4access to the above scr d premises at any reasonable time for the purpose of inspection. m ; m <br /> SIGN HERE 7 i ro <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> N N w " N room <br /> N N O N0 N O m <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 8 6 0 8 u) <br />