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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator w o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 0 <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 accor- <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 /> OWNER , y TELEPHONE � ^p o <br /> ) <br /> l� mV <br /> HOME ADDRESS --~ IiN <br /> CWS� r) <br /> EMERGENCY/FIRE NUMBaas�:� 7� 7/ <br /> 1� hQ .C�) � ROAD NAME yd3 l n' <br /> LEGAL DESCRIPTION(see tax receipt) /17 <br /> ..yy1 <br /> CONTRACTOR e dU9 <br /> �7�a1�QJ lILDAa / Cf��1n/A(1�(�1�(/J/3 r�f� /�(af� JYdLI/NL <br /> / v <br /> � / / <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE V ADDITION o <br /> � r <br /> y O <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> j� r � o <br /> STRUCTURE/ADDITION USE: 1 In/ / oa� <br /> (Home/Cab n; Commercial B iness;Bedroc ; Deck;etc.) <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. ,, I <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O B <br /> m 'P rn <br /> 1. All required dimensions or distances to be shown or drawn to scale. p P CL <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB)and indicate m y <br /> North (N). ai � <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. tU (n <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildings, Su <br /> roads, lake, lot lines. I C <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. • GO <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be w <br /> signed and dated by the owner. I v, <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <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: <br /> N <br /> n <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 <br /> PERMITTED. <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 /> 6. <t° <br /> rn (nvrnrDDO � <br /> s m <br /> on M 0� -'n m -m <br /> 7. a y' : Z N O f� <br /> Z7 T cn' <br /> 8. �,: m <br /> N : C <br /> o ate : C <br /> CD m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my , m <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofv y V t7 <br /> all information contained in this application(Including any accompanying schedule)and I further declare that I recognize o 2 o <br /> o , o ; <br /> that this information 1 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 <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 the above described premises at any reasonable time for the purpose of Inspection. T m <br /> N <br /> SIGN HERE <br /> N ; <br /> not or building contractor) <br /> a (date) o <br /> ' o <br /> ZONING ADMINISTRATOR E <br /> T,1i T <br /> -+ NNtnN Cn <br /> TOWNSHIP PERMITS MAY BE REQUIRED' o u u o v o <br /> 08000 <br /> a <br />