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in'l e <br /> Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator 0 0 <br /> APPLICATION FOR LAND USE PERMITS E 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work g <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- <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. Hm <br /> ala- ya3- iso/ ?L = A o <br /> OWNER L <br /> �Or14_ TELEPHONE -7 <br /> /� C o , Gc,1iCLC-50rN 02 7-� <br /> HOME ADDRESS F�Irl lAet./ Q�e C�1� � /FYI <br /> EMERGENCY/FIRE NUMBE / ROADNAME I Li p7_/� jS 23 <br /> LEGAL DESCRIPTION(see tax receipt) CS 6r) (Od�� � oevl-/y`Ucl-/S <br /> CONTRACTOR e q <br /> rom pa.—c� C Y�nst <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION 0 .�.- <br /> N 4 �I <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o ° <br /> a a <br /> STRUCTURE/ADDITION USE: '(oXa3OM cSµn Poor,-, (Qt(/D D¢cJ, ° <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> a 7Z!—. <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> T P Co <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 m N: <br /> North (N). M 1 ° <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s) to centerline of m n <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. I C <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. (jl <br /> v 8 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. , <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 <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. 9 <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. I <br /> 6. <br /> rnmvmrD DF '17 <br /> < C N O j 3 <br /> %"o V] <br /> Z f O Utz <br /> 6. o — <br /> N 62i m <br /> m m <br /> o <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my S <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of g„'m O <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- o , o <br /> o 0 <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 O p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other3 2 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. r i 'O H <br /> m <br /> SIGN HERE .(7,.�c•� J/��96 y ; nd'i i E <br /> (signature of o or building contractor (date) [ o <br /> ZONING ADMINISTRATOR �.J(�Yl l�idi1 <br /> t»tn�F»e>tn j' �I <br /> N N t f N N N (1 t m <br /> TOWNSHIP PERMITS MAY BE REQUIRED o v u o v u u o m <br /> - o0000000N <br />