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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator U) m o 0 <br /> APPLICATION FOR LAND USE PERMITS - 3 <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for th work � <br /> described and located as shown herein. The undersigned agrees that all work shall be done in ccor- 3 R <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with al other - o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. H w <br /> �d <br /> OWNER TELEPHONE '— o <br /> G <br /> HOMEADDRESS '�27 — S/�A = iP - <br /> EMERGENCY/FIRE NUMBER ROAD NAME 5-��� l <br /> foJ <br /> LEGAL DESCRIPTION(see tax receipt) S'z tr 341 ye) .v <br /> CONTRACTOR S�-L /= o <br /> p o <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE �'�C-/"ADDITION <br /> y O <br /> p J <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION v <br /> o <br /> Peg <br /> p v <br /> STRUCTURE/ADDITION USE: / eg/1 C '7 <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 O <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 'n 3 <br /> T ? m <br /> 1. All required dimensions or distances to be shown or drawn to scale. o a <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings (NB)and indicate In N: <br /> North (N). H <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerlinG of m <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildings, Uj <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. <br /> i4 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE <br /> -FORE A PERMIT CAN BE ISSUED. ( `I <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 a <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELIN . <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 T E I� <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. { <br /> 5. <br /> F <br /> 6. <br /> Ny D DO y <br /> o, c =. <br /> 7. � K' waC� REM <br /> V <, Z. : <br /> 6. = F ' Ty : 31 <br /> P N t O C [ m <br /> o : 6 C C <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best a my -� ` M <br /> knowledge p g a and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accur cy of f^m m <br /> c, 'm g'„ m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I rec gnize o o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whath <br /> ei to is- $ <br /> 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 E m <br /> al N <br /> SIGN HERE w <br /> (signature of owner or building contractor) date N <br /> ZONING ADMINISTRATOR ' <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N N N N N U m <br /> ornlno �n <n lnom <br /> 000 $ 0000N <br />