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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator m c o <br /> APPLICATION FOR LAND USE PERMITS d 3. <br /> z <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work � y <br /> described and located as shown herein. The undersigned agrees that all work shall be done inactor- 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 regulations of the State of Wisconsin. y m <br /> c ;? <br /> MI6 _6E' rSLI�lE5C7IIC?3L� <br /> OWNER TELEPHONE m m <br /> HOME ADDRESS .. tj <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CONTRACTOR <br /> 0 <br /> �p o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION <br /> y O <br /> O " , <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> - <br /> 0 <br /> STRUCTURE/ADDITION USE: 06 V. / 5 f . / ! 1, / <br /> t I <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> O <br /> z 8 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O a <br /> m P <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 Q N <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 I I <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. i <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. U <br /> ri <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 /> 3. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT l <br /> ISSUANCE. ILS <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY n <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 /> rnmvfnroD Dy <br /> 7. m � $� '» a00 �' M <br /> w A >D Z <br /> = F <br /> '0 <br /> B.8. ` N c,2 i i m <br /> o : ate : C <br /> of y <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my -- : m: : m <br /> knowledge and ballet It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of �,' ': O <br /> 00 0 : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> that this Information I am providing will be Burnett upon by the County of Buett Wisconsin in determining whether to Is- o : o <br /> 1ti�E <br /> sue a permit. I further accept all liability which may be a result of the County of Burned relying on this Information I am i O p <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described promises at any reasonable time for the purpose of Inspection. m i <br /> a <br /> N <br /> SIGN HERE v <br /> (signature of owner or building contractor) (date) [ o E E <br /> ZONING ADMINISTRATOR <br /> �J �NNfINNNN m <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 D o m <br /> 00000goofll <br />