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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator W 7 0 0 <br /> APPLICATION FOR LAND USE PERMITS d 3. — <br /> 0 <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 n <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 /> OWNERTELEPHONE \,S• 0�� I��V o m <br /> �'�e1,we� -!- StieRy� Jo�h'Sor� <br /> m <br /> HOME ADDRESS ���3 `� 1� b 1r1 , 1��_3n <br /> V1 V n t l D <br /> EMERGENCY/FIRE NUMBER LA �)z ROAD NAME I <br /> OKn�� <br /> —r <br /> LEGAL DESCRIPTION(see tax receipt) D <br /> �/ <br /> CONTRACTOR <br /> m � <br /> Cb <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAG ACCESSORY STRUCTUREV" ADDITION <br /> N O <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION— <br /> STRUCTURE/ADDITION <br /> UBDIVISION STRUCTURE/ADDITION USE: G Re A4 e <br /> (Home in; 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 /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> -n P a1 <br /> T Z c <br /> 1. All required dimensions or distances to be shown or drawn to scale. P a <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB) and indicate H <br /> North (N). m d <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) building(s)to centerline of <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM) of lake, stream or river. w <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildings, Z <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 <br /> signed and dated by the owner. I <br /> O » <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. 2. <br /> Q <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 <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. <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 /> 6. <br /> 7. x � a ' nma £ m <br /> m = 70 <br /> m m3: ' cyo ' 3 <br /> < N [ z N O b <br /> _ <br /> o — m <br /> 8. 'c <br /> o <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my y: i m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of N'm $;; O <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o o : <br /> o , o : <br /> that this information I 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 3 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m ? !^ <br /> m . <br /> SIGN HERE <br /> (sig o wner�Ing contractor) (date) i o i i <br /> ZONING ADMINISTRATORF. p <br /> v+F»E»� -n <br /> TOWNSHIP <br /> N N O N N r n m <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 ' o ao o m <br /> 0000 o600 <br />