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en Geyiy, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator w m o 0 <br /> APPLICATION FOR LAND USE PERMITS 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- `, <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other 3 (� <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> 0 <br /> OWNER e �r I�V' 1 a O <br /> TELEPHONECD <br /> 0)/_'�7 w <br /> HOME ADDRESS g�'� �req� �I rC� &�rni t) `7 y7 /1� / e_ <br /> EMERGENCY/FIRE NUMBER 1 ROAD NAMt <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CONTRACTOR <br /> YYY VVV v'G o �_ <br /> � o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE X ADDITION 0` <br /> y r <br /> 0 <br /> o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> �7 c v l <br /> STRUCTURE/ADDITION USE: C ► <br /> (Home/Cabi , ommercial Business; Bedroom; Deck;etc.) <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. m <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> O v w <br /> 1. All required dimensions or distances to be shown or drawn to scale. n o <br /> 2. Show the location and size of all existing buildings(EB)and all new buildings(NB)and indicate m N. <br /> North (N). y 0 <br /> 3. Show dimensions in feet of the following: m <br /> (a) building(s)ng(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. SO <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildings, UJ <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. ((( <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. - <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. m U <br /> CONDITIONS OF PERMIT: v <br /> N <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 1 ? <br /> PERMITTED. D <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. V 1 <br /> 5. <br /> 6. ��h va_ r <br /> rntnvrn� DD � <br /> 7. io 4. a ' a� $ m <br /> m N y. 'Z y 7 f0 <br /> Z F 5 ' TQ0 -1 <br /> 8. c =y: M <br /> A <br /> 0 m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my — wm <br /> knowledge and belief it is true,correct and complete. I 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 o o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- o : 00 <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 o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 2 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. (T ? N <br /> �J Cj N 41 <br /> SIGN HERE . ; . <br /> (signature of owner or b Ing contractor) (date) <br /> C O : <br /> ZONING ADMINISTRATOR 0, f Ian 4; ng ' <br /> io_ <br /> Ensntnn <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N N N N m fl1 (T O00000 (A <br /> 00 <br />