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079 �-" <br /> Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator m m -- 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work z s <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- R n <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 /> F9a <br /> OWNERAL / rrfl�/ y� TELEPCHONE <br /> c�fi rCz/� rse� 7/5-63.s`- S30S/ <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER / 3 ROAD NAME �� Q <br /> o <br /> LEGAL DESCRIPTION(see tax receipt) ',{ L/ ,L,. /3 4 J to re, N- /Irz <br /> CONTRACTOR Jj- <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION »' (0 <br /> N O <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> - <br /> Z o <br /> a <br /> m <br /> STRUCTURE/ADDITION USE: Sfo ra e <br /> (Home/Cabin; 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. In <br /> O <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> -n 3 <br /> 71 P rn <br /> 1. All required dimensions or distances to be shown or drawn to scale. n o a <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB) and indicate m <br /> North (N). (a <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s) to centerline of m <br /> i <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. p <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildings, C-13 <br /> roads, lake, lot lines. Z <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. r m <br /> R <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- a <br /> FORE A PERMIT CAN BE ISSUED. (� <br /> N <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. �J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. J <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> f <br /> 6. <br /> NN N D D O y <br /> M 0, QM. 0 �8 � F m <br /> _. m <br /> 7. e N 2 41 o � g C <br /> 9 N o : `2 <br /> 8. ' m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my o <br /> knowledge and belief it Is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of m <br /> 9 P 9 P Y v, mN : O <br /> all information contained in this application(Including any accompanying schedule)and I further declare that I recognize o a o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> o : o : <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 n p <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 th ove descri d premia at any reasonable time for the purpose of Inspection. n v y <br /> m <br /> SIGN HERE <br /> is na re of owner Iding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> m <br /> r,. . NN N NN m <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> o " m <br /> 00000'000 rA <br />