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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ,� M 0 0 <br /> APPLICATION FOR LAND USE PERMITS 2. <br /> w 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work y <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- ` <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other 3 <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y m <br /> n c v <br /> OWNER VQ D I�11lli�� C� TELEPHONE a <br /> 7 1 ,n/ v <br /> HOME ADDRESS n y� _I a �P i � ,7-- <br /> EMERGENCY/FIRE NUMBERV 1 CROAD NAME 01 <br /> LEGAL DESCRIPTION/(see tax receipt) �C1 ���A / )41, <br /> CONTRACTOR <br /> 6 <br /> r � <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE ADDITION 0 .: <br /> N <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> Cpm <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;et .) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR V- <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. o <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> r p w <br /> 1. All required dimensions or distances to be shown or drawn to scale. cTi o a <br /> 2. Show the location and size of all existing buildings(EB) and all new buildin s (NB) and indicate m <br /> North (N). ch ° <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of m I n <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. �J <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and II distances to buildings, <br /> roads, lake, lot lines. <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or f Iled. C:) <br /> 6. If separate plans are submitted by an architect, engineer, builder, contracto , etc., the plans must be <br /> signed and dated by the owner. <br /> O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- 0 <br /> FORE A PERMIT CAN BE ISSUED. _ <br /> 2. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> N / I ' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W <br /> ISSUANCE. �vI <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLES SPECIFICALLY ? <br /> PERMITTED. ` :lj <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTE V� <br /> 5. <br /> 6. <br /> mfnvm DDOy <br /> 7. m 4c4 '— 'o. m $mm <br /> a _ <br /> m ma. i °' CHoSic <br /> moE <br /> Z f = Tc . <br /> m <br /> N : V7C ; <br /> 8i <br /> m m : <br /> I declare that this application (including any accompanying schedule) has been examine I by me and to the best of my i ' [ , m <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsibli i for the detail and accuracy of <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize ' .0 o <br /> PP (� 9 Y ) 9 E o1e o ; <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsi in determining whether to Is- i <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett r Oying on this information I am <br /> providing in this application. I agree to permit county officials charged with administers ig county ordinances or other 3 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m v m E <br /> m : <br /> SIGN HERE <br /> N ; <br /> (signature of owner or building contractor) (date) o <br /> —Tim 9CI4 <br /> o ; <br /> ZONING ADMINISTRATOR <br /> w fn F»�ea Fn fn T <br /> N N O i N N N N <br /> TOWNSHIP PERMITS MAY BE REQUIRED " " mm <br /> 00000000N <br />