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&) <br /> Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 5 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for th' work <br /> e <br /> described and located as shown herein. The undersigned agrees that all work shall be done inccor- 3 <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with al other o <br /> 8. <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. N w <br /> OWNER ' TELEPHONE 7/5y^Z' <br /> Cr�eN /29i'e 'L 3 - Ia m <br /> m <br /> HOME ADDRESS Ce - c .2.T. z�L rs d ry <br /> EMERGENCY/FIRE NUMBER2 _?4 <br /> /� ROAD NAME <br /> a 4'R 'v@ D <br /> LEGAL DESCRIPTION(see tax receipt) �!7/T'3 SR f 7 f e>-r2, e 5/✓/ V <br /> \V <br /> CONTRACTOR tx3 Aj (, c, <br /> o M <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE-ADDITION <br /> m o <br /> o' <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: oo wl - P.d O /K - 13A r IY-" <br /> (Home/Mn;n;Commercial Business; Bedroom;Deck;etc.) <br /> r <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. r <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 <br /> T ? m <br /> T o <br /> 1. All required dimensions or distances to be shown or drawn to scale. ?5 <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB) and indicate m T. <br /> North (N). y <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of m I r_�, <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or ri%er. S r <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. I C <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 mus be <br /> signed and dated by the owner. Cro <br /> Ul � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION - ° <br /> FORE A PERMIT CAN BE ISSUED. © _ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. �I <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMI A I <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLYI 9 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF HE I` <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. SIV <br /> 5. Ey/S>4nc� /0 <br /> + d4_ Is /No&coa -Tv_mt_� 6,e- <br /> 6. 6.11 Al reply,f �ftw /ke_-et iJ5 r'� ${� Ar L F <br /> corn CD r­ 0 <br /> D O 'y <br /> c =. wS $ f <br /> 7. :oR <br /> n �yy om <br /> SvL HJT/ ��'.". \ PV111"4 .y J' (� / < N : N o m 3 <br /> F o ' -Ni E 7J <br /> 8. o — <br /> m <br /> € o ; <br /> L5 : C <br /> m m <br /> 1 declare that this application (including an accompanyingschedule has been examined me and to the be of m m m <br /> PP ( 9 Y ) by Y <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and acc racy of C" ' E •$1 O <br /> all information contained In this application(including any accompanying schedule)and I further declare that Ire ognize o 0 <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whet h r to Is- ' <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this infonnati n I am O 0 : <br /> providing In this application. I agree to permit county officials charged with administering county ordinances t r other ? `� <br /> authorized person to have access to the above described promises at any reasonable time for the purpose of Insp oction. <br /> B <br /> SIGN HE h <br /> a roof"nor thin,, contractor) ! h ro <br /> ( � g (dere) <br /> o i i <br /> ZONING ADMINISTRATOR ✓ <br /> -n <br /> O N r T O N N r n O m <br /> TOWNSHIP PERMITS MAY BE REQUIRED !'' ' m <br /> t'. . I� i S$ c8$ S000t/1 <br />