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CgN Ck"Yl'� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator on - -- o <br /> APPLICATION FOR LAND USE PERMITS w 3. <br /> a <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work y oQ <br /> described and located as shown herein. The undersigned agrees that all work shall be done in i ccor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other v <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> eL o <br /> OWNER E e TELEPHONE <br /> m <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME FZ <br /> LEGAL DESCRIPTION (see tax receipt) _ - I tAr go % ( 1 CS,- QA rL-4,o i �1 <br /> CONTRACTOR S r t NN —QkC-1 <br /> °< <br /> TYPE OF PERMIT(S): DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ADDITION 0 -r <br /> N w <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o � <br /> STRUCTURE/ADDITION USE: VL.3 6M,t—' Sani <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 O <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n <br /> O <br /> A S) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 U�) <br /> n P rn <br /> T o i� <br /> 1. All required dimensions or distances to be shown or drawn to scale. t7 <,f <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB) and indicate m N <br /> North (N). in 1 ' <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) building(s)to centerline of m <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. -Q" D <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildi gs, is <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. x <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE <br /> -FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. (� <br /> CONDITIONS OF PERMIT: 4 <br /> N <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 9 <br /> PERMITTED. q 1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF 1 HE 1 Ij <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. l� <br /> 5. <br /> � DM eS ilPc � f ��3p 9 ° Q � = Ba £ m <br /> 7. <br /> Z <br /> 8. o [ ?»E m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the bestof my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accu acy of y N E p <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize o o <br /> o , o : <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 1 am O p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances o other <br /> authorized person to have access to the above described premises starry reasonable time for the purpose of inspection. <br /> SIGN HERE 'PNd' <br /> N <br /> (signatur eror building contractor) (date) - : o <br /> ZONING ADMINISTRATORSEP <br /> Im <br /> TOWNSHIP PERMITS MAY BE REQUIRED I� N N N N N N <br /> jj,� o ,vi ,vi o P un o <br /> �� 0 0 0 0 0 0 0 0 <br /> x �s <br />