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Ort CUW , <br /> Burnett Cbunty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator U - 0 0 <br /> APPLICATION FOR LAND USE PERMITS d 3 <br /> z s <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work � N <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 o <br /> applicable County Ordinances and the laws and regultions of�tppe State of Wisconsin e <br /> Booz-- `iSS- 5sz6 lob-"1-1'11 g n <br /> OWNER 5014 fJ W I LLA R0 TELEPHONE G 12� $� , OO,I.' p <br /> HOMEADDRESS 11028 Qrd WiLDln1l G1✓. 1300M/IfG'�"OAlvy.MAI, 5Yg31 'T v <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) ( / <br /> CONTRACTOR — <br /> v <br /> o Qi <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-X—GARAGE/ACCESSORY STRUCTURE—ADDITION— <br /> SANITARY <br /> TRUCTURE ADDITIONSANITARY PRIVY F LLING/GRADING CAMPING UNIT SUBDIVISION <br /> Z <br /> a .^ �7� <br /> STRUCTURE/ADDITION USE: �l/I' I -t�'1 lL D <br /> (Home/Cabin; Commercial Bu i ass; Bedroom; Deck;etc.) OG <br /> o <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR .9 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> n 3 <br /> m P CD <br /> 1. All required dimensions or distances to be shown or drawn to scale. n a <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB) and indicate m <br /> North (N). 0 <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) building(s)to centerline of m \ <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. Y K <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildings, iu <br /> roads, lake, lot lines. ICt <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 /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> o - <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 U� <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 a <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. Lr� <br /> 5. <br /> F <br /> 6. <br /> ur rnvrnr D Doy <br /> o, a M. f <br /> 7. g <br /> 9 N O ? 00 0 i <br /> Z F O = y <br /> 8. : i —621 i m <br /> o i <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my � �m E m <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> PP (including Yaccompanying ) recognize <br /> all information contained in this applicationan schedule and I further declare that 1 ' o !^ o E <br /> that this information 1 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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other j 3 i `k <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. y E <br /> T N <br /> SIGN HERE <br /> G fit;'` $ <br /> S o <br /> ZONING ADMINISTRATOR i E i E <br /> m <br /> TOWNSHIP PERMITS MAY BE REQUIRED c c o0 0 0 o m <br /> I oo� 000N <br />