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0n ems, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator w m -- 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 /> c <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 ofiscgn n. <br /> 41, <br /> OWNER J� <br /> , TELEPHONE 7t �, CD <br /> L w <br /> HOME ADDRESS qD 55 I a <br /> CD <br /> t <br /> EMERGENCY/FIRE NUMBER <br /> LEGAL DESCRIPTION(see tax receipt)) O <br /> CONTRACTOR C l F o ` <br /> 1 � oTYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE�,, // ADDITION o <br /> W O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> Z o <br /> P <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> r <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 /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 0 3 <br /> n P rn <br /> 1. All required dimensions or distances to be shown or drawn to scale. 0 o a <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB)and indicate m S. <br /> North (N). y <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. <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 — r <br /> signed and dated by the owner. I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <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 /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT » <br /> ISSUANCE. O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Z <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE <br /> 5. OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 6. <br /> corn -Urnr DDO -0 <br /> 7. z 0a MW 'no0 m <br /> am M <br /> O > <br /> 8. <br /> P _ 2' . M <br /> of iu » ` A <br /> 8i o , i C <br /> S : : ID <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G): ' M <br /> knowledge and belief It is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of �'m � p <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize c <br /> , o ; <br /> 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 /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am n p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other3 8 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T v y <br /> O=hm <br /> y <br /> SIGN HERE h ifl <br /> (signature of owner or building contractor) (da ) o <br /> ZONING ADMINISTRATOR �J I(11 �(�f o�(1 o <br /> farA69 'l <br /> NNfn N N N fn <br /> TOWNSHIP PERMITS MAY BE REQUIRED o p, cn o u u u o m <br /> 00000000Co <br />