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0� cA)qq <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR LAND USE PERMITS 5 3. o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work 2 a <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- D <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. 0 o <br /> OWNER �C;Ile y f / Q TELEPHONE7 _ •_3 �� o <br /> LLL--- G I / m <br /> HOME ADDRESS AYl`p,./p ni G `/ '5 1/g3z J <br /> /r l5 t-�C� �� Y, J_ <br /> EMERGENCY/FIRE NUMBER ROAD NAME ep• C.��yl �au;i <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> O <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION 0 <br /> N 0 <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> Z o r1 \ <br /> STRUCTURE/ADDITION USE: Am m Y �.,` 14 03 <br /> (Home) abin;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. m <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> 11 v N <br /> T o F <br /> 1. All required dimensions or distances to be shown or drawn to scale. n <br /> 2. Show the location and size of all existing buildings(EB) and all new buildings(NB)and indicate m �t o <br /> North (N). C <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline 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 buildings, <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 Uj 10 <br /> signed and dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- a ° <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 /> s <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 0N <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 (�f <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> 6. O POyef,, I/�1 1/t11 /'115 <br /> I I il'-(t/I-- ��}/�L�'1 I /�// rpNVrn Da m <br /> / LO a 4.c �. � ✓jSa m <br /> 7. m $.� - am c:1D <br /> 8. o _ Cn <br /> N c 71.Via : O <br /> o : ac : C_ <br /> m m : ' <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my ` A <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of D <br /> all information contained in this application(including an accompanyingschedule and I further declare that I reco nize oro o <br /> PP f 9 Y ) 9 fD 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 0 : 0: <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 ; x <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> J <br /> a 1 . <br /> SIGN HERE <br /> (signature or building contractor) (date) o <br /> ZONING ADMINISTRATOR <br /> J im la ni , <br /> , ������0 -n <br /> N N N N N N N <br /> TOWNSHIP PERMITS MAY BE REQUIRED cn a o N 0 0 o m <br /> 0000000U) <br />