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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator d m o 0 <br /> APPLICATION FOR LAND USE PERMITS w 3. <br /> TO THE 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- 3 <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other - <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y <br /> OWNER TELEPHONE y6 C p C <br /> d <br /> m <br /> HOME ADDRESS J 7 /_ (YJ y) 0 � r J�� /�„y <br /> EMERGENCY/FIRE NUMBER .) T /�ll� ROAD/NAME//` 0 up� <br /> �- a <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CONTRACTOR /'" /� m <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ CESSORY STRUCTURE ADDITION 0 - <br /> y O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION v <br /> 0 0 <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business;Bedr m;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. T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> -n 3 <br /> 1. All required dimensions or distances to be shown or drawn to scale. n o a <br /> 2 Show North the location and size of all existing buildings (EB)and all new buildings(NB) and indicate m C) j: <br /> 3. Show dimensions in feet of the following: a building(s)s to all lot lines b building(s)s to centerline of m l <br /> s <br /> O ngO , O 9O <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, 0 O <br /> roads, lake, lot lines. L <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. r� b C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- C ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> N <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 SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ? <br /> PERMITTED. :b <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE <br /> 5. �- <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 6. <br /> o c m D D y <br /> 7. DFL1 � CL(D m <br /> 0 CD <br /> 8. u F ' y 77 <br /> N 3 a <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my w: m <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of y &A: p <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize E o m o <br /> , <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- o : o :oo ; <br /> sue a permit. I further accept ability which may be a result of the County of Burnett relying on this information I am p <br /> providing In thi Iication I a e to perm) unty officials charged with administering county ordinances or other <br /> authorized p on t have cce o t ab scribed premises at any reasonable time for the purpose of inspection. T m <br /> SIGN HER <br /> (signature of owner or building contractor) (date) 00 <br /> ZONIN ADMINISTRATOR <br /> 0 : <br /> wF»`�ifliflw�' In <br /> N N f J 1 N N N W m <br /> TOWNSHIP PERMITS MAY BE REQUIRED O p N5 in 6 N O <br /> 000B0Sg0 <br />