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On (OPT <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m m o o <br /> 2. <br /> APPLICATION FOR LAND USE PERMITS w 3' <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit forth work � N <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- 3 <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with a I other — o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. FC <br /> y m <br /> OWNER TELEPHONE _ a o m <br /> HOME ADDRESS 7 1III'Ds. Vr ,. <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> � < W <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> � r <br /> m o <br /> � 0 <br /> SANITARY V/ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION- <br /> STRUCTURE/ADDITION <br /> UBDIVISION STRUCTURE/ADDITION USE: S <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; c.) <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. O <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 N <br /> T Z v <br /> 1. All required dimensions or distances to be shown or drawn to scale. m o a <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB)and indicate <br /> North (N). m <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 <br /> signed and dated by the owner. Ul <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION3E- <br /> FORE A PERMIT CAN BE ISSUED. <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERM IT a <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOREL NE. `U <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ? <br /> � 9 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE I�'1 <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> s. �.�1-e p <br /> .� x 4Q � �w�i $ £ m <br /> 7. <br /> N 0 y. : `2 N O a 3 <br /> Z Fes : ;I C' M <br /> 8. u �i � � m <br /> Co : 0 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the b st of my <br /> d d m <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and ac ;uracy of <br /> oo : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I cognize E o !a ob <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining who Ner to is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Informi tion I am O E o <br /> providing in this application. I agree to permit county officials charged with administering county ordinance or other 3 x <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of in pectlon. <br /> N N <br /> A <br /> i <br /> SIGN HERE <br /> signat%80 <br /> o o or or 11 In ntractor) (date) <br /> ZONINGADMINISTRATOR b; <br /> Ow En F9 TF»F»En <br /> N N N 5"5 <br /> T <br /> oNN ( oTOWNSHIP PERMITS MAY BE REQUIRED 000o00m <br /> 0 0 0 0 0 0 0 o m <br /> Uq-a) 9s <br />