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01cffi_YWr <br /> Burnett County,7410 Ga. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator w - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3' <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit forte workSjj <br /> described and located as shown herein. The undersigned agrees that all work shall be done 111 accor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with aII other 3. o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y d <br /> OWNER �/ L N�S� TELEPHONE o �1 <br /> V, I I d I <br /> HOME ADDRESS lJ0 j ' " ;t- m� C <br /> �.'U 1-111 <br /> } <br /> EMERGENCY/FIRE NUMBER ROAD NAME rr�rr <br /> VA <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CONTRACTOR >_ <br /> C o <br /> � o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION 0 =' <br /> N O <br /> O <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION__JL <br /> _ � v <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. r <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) p 2 <br /> T 7 (n <br /> 'nZ C <br /> 1. All required dimensions or distances to be shown or drawn to scale. n9 <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB) and indicate m y <br /> North (N). m I <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerl ne of <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM) of lake, stream or I iver. <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buil ings, <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 ITIL st be S <br /> signed and dated by the owner. �} <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- Q ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> 2.0 <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 PER <br /> ISSUANCE. QQ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �rj F <br /> PERMITTED. p <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE r <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. (� <br /> 5. <br /> f <br /> 6. p <br /> w mwA _$ £ m <br /> m <br /> 9 N <br /> 7. m N d C In 0 J M <br /> A. <br /> M <br /> o ' <br /> 8. d — in <br /> N 7 C <br /> pi <br /> o 3I <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the b Pat of my : . : , m <br /> knowledge and belief It is true, correct and complete. I acknowledge that I am responsible for the detail and ac uracy of <br /> PP (including Yaccompanying ) g oto o <br /> all information contained In this application Ineludin an schedule and I further declare that I co nlze � ? m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining who her to is- 8 :, b o <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Inform tion I am p <br /> providing In this application. I agree to permit county officials charged with administering county ordinance 3 or other , 3 , 8 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of in ipection. <br /> w <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) o <br /> ZONING ADMINISTRATOR <br /> winw 'www j' �I <br /> NN N N N N <br /> TOWNSHIP PERMITS MAY BE REQUIRED o u m o y u N o N m m <br /> 00000000 <br /> 0000000o CA <br />