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Burnett Gbtinty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m -1 a o <br /> APPLICATION FOR LAND USE PERMITS 3' o <br /> TO TH'E ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- 0 & }* <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all othero r 0C, <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. m <br /> ' 2 <br /> OWNER VIt l.— C[O�A'�IO��1 /� I. I/ TELEPHONE �IIL _ Q/tq Q4I I <br /> HOME ADDRESS /"IYD C� l�O YI WGBST6K ' 1 1` I✓- SUM <br /> U /M') <br /> EMERGENCY/FIRE NUMBER L-, ROAD NAME I <br /> LEGAL DESCRIPTION(see tax receipt) 93 <br /> CONTRACTOR <br /> G) <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE—ADDITION- <br /> 0 <br /> O <br /> V <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> m <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) r- <br /> c <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) T 3 <br /> Z C <br /> 1. All required dimensions or distances to be shown or drawn to scale. m ° <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB)and indicate . 0 <br /> North (N). to <br /> M <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of <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, <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 ) �Q� <br /> signed and dated by the owner. " g <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. N <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O. <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY D <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 /> f <br /> 6. <br /> S Q. <br /> C M ' g M <br /> 7. cy °.a3 <br /> P - m <br /> 8. Ni Oma : O <br /> o : nom : C <br /> �i <br /> I declare that this application (including any accompanying schedule) has been examined by or me and to the best of my m <br /> m l7 <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of f oro o <br /> I further declare that I recognize <br /> all information contained in this application(including any accompanying schedule)and o m b <br /> 0 0 <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether 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 i , o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other i3 ; <br /> m ; <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. mm <br /> I 9 IE N <br /> SIGN HERE ""^"�" (dat ) <br /> o ; <br /> ZONING ADMINISTRATORi» -n <br /> N N n N ro N N m <br /> pp, O� OOip Nn <br /> TOWNSHIP PERMITS MAY BE EQUIRED o 0 o 0 0 O c o w <br />