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(UY�Lp <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Adminisilrator m 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 the work 42 0 <br /> � y <br /> described and located as shown herein. The undersigned agrees that all work shall be done in ccor- 3 <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 I/ V -T-A)C ; TELEPHONE <br /> HOME ADDRESS 03 <br /> .yt 5 5715 <br /> EMERGENCY/FIRE NUMBER ROAD NAME I <br /> LEGAL DESCRIPTION(see tax receipt) ZG <br /> un &" U { //5 <br /> CONTRACTOR nyG <br /> _o C <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING- GARAGE/AC SSORY STRUCTURE ADDITION 0 <br /> a <br /> SANITARY PRIVY FILLINLIGRADING C PING UNIT SUBDIVISION <br /> /-/, /� / L o a° <br /> STRUCTURE/ADDITION USE: �-+�61 ✓( x i�l� / /OX /2, r &e <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 OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> -n P rn <br /> 'nZ c <br /> 1. All required dimensions or distances to be shown or drawn to scale. F) p <br /> FL <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings (NB)and indicate In d N: <br /> North (N). y <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerlin of m <br /> road, (c) building(s) measurement to the ordinary high water mark (OHWM) of lake, stream or riv r. OQ <br /> d a <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildi gs, <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 r <br /> signed and dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION B <br /> FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o �, <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMI / <br /> ISSUANCE. y" ) <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 I HE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> 6. <br /> nnvv � na � v <br /> M o, c �. > > 8 $ m <br /> 7. m01cyo � <br /> N O P-`2 <br /> Z Fo 7!w : <br /> 8. o — In <br /> a O <br /> o a � C <br /> o <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 of <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 whethe 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 Information I am n o E <br /> providing in this application. I agree to permit county officials charged with administering county ordinances o oth 3 <br /> authorized person ave acces to the ove d scribed premises at any reasonable time for the purpose of inspection <br /> T ; m <br /> (s nat roof ow r r Ildin contractor 'Tin <br /> SIGN HEREV a ) �, ; N <br /> r <br /> �� � � � . . ..:_(date) <br /> i o i i <br /> ZONING ADMINISTRATOR e-l®� <br /> w(»E»OLL: � T <br /> NOV 8 1995 <br /> TOWNSHIP PERMITS MAY BE REQUIREDI 0 0 0 0 0 0 0 0 <br /> � :5e f T7— <br />