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51 cwx p, <br /> Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator T -+ <br /> APPLICATION FOR LAND USE PERMITS <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work 3 <br /> described and located as shown heroin. 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 o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. w <br /> v <br /> OWNER TELEPHONE <br /> HOME ADDRESS Q / /, , <br /> EMERGENCY/FIRE NUMBER (� /� r1 ROAD NAME D <br /> LEGAL DESCRIPTION(see tax receipt)(, <br /> CONTRACTOR <br /> TYPE OF PERMIT(S):DWELL G/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITIONy,:�5,' <br /> N O <br /> O '- <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ' pp <br /> STRUCTURE/ADDITION USE: T <br /> (Home/Cabin;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. T <br /> O <br /> XI i <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 <br /> O <br /> 71 P Cl) <br /> 1. All required dimensions or distances to be shown or drawn to scale. n o S <br /> 2 Show the location and size of all existing buildings(EB)and all new buildings(NB)and indicate c <br /> North : <br /> ( ) N <br /> LW <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(WW), septic tank(ST)and drainfield(DF), and all distances to buildings, 3 <br /> roads, lake, lot fines. <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 d x <br /> signed and dated by the owner. <br /> i 8 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. I �, <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: a <br /> S. <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. :13 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE <br /> 5. OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 6. <br /> knvkn V <br /> 7. 9 �• m <br /> Ki <br /> 8. <br /> m <br /> I declare that this application(including any accompanying schedule) has been examined by me and to the best of my ' m <br /> knowledge and belief It Is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of <br /> all Information contained In this application(Including any accompanying schedule)and I further declare that I recognize °$ <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 g <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection.44 <br /> r io <br /> SIGN HERE N <br /> (signature owner or bundling contractor) (date) <br /> ZONING ADMINISTRATOR _ �m 1F�lQ4 1 �� ? ? g ; <br /> TOWNSHIP PERMITS MAY BE REQUIRED CMD <br />