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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator cm o 0 <br /> APPLICATION FOR LAND USE PERMITS 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 inaccor- <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 w <br /> c m <br /> OWNERop')NC �, Hem P) <br /> TELEPHONE <br /> HOME ADDRESS _3 g-� /t J�✓�!r/�� ltiTµ 1 '' l. <br /> �v 11 vz ��1 11 C3' <br /> EMERGENCY/FIRE NUMBER )a- 1 738' ROAD NAME <br /> m <br /> LEGAL DESCRIPTION(see tax receipt) eO'r - V, ; ->I6UV <br /> A <br /> CONTRACTOR t-n At-.w E` Golj p 0 <br /> 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 v <br /> 0 0 <br /> m <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. In <br /> O ' J <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> m p rn <br /> 'n o a <br /> 1. All required dimensions or distances to be shown or drawn to scale. <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB)and indicate m L. <br /> North (N). ami <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s) to centerlir a 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 buildi-1gs, <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 i <br /> signed and dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATIONBE- <br /> FORE APERMIT CAN BE ISSUED. <br /> N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: q <br /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMI 2 <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELI JE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY I Z <br /> PERMITTED. mb <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. e�{r��RA-E� BE Z/0 ' rzam Caen r�>� <br /> 1 F, pro. x o a d 8 $ m <br /> 7. < < : wcyos <br /> Z F '0 : <Q <br /> 8. ? i - <br /> ut : E5 2 m i Q <br /> of m C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the bet of my <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and acc iracy of N y p <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I re ognize [ o o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining wheth r to is- <br /> o : o : <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this informat on I am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances r other 3 ? `� <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Insl action. <br /> p <br /> A N <br /> uu�� _ N <br /> SIGN HERE / No <br /> (signature of owner c#buildi contractor) (date) o <br /> ZONING ADMINISTRATOR <br /> �r0PO � T <br /> N N N N N N N m <br /> TOWNSHIP PERMITS MAY BE REQUIRED o . . 0 0 0 0 o m <br /> o0000000rA <br />