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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ,� 0 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for t e work 0 y <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 0 <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> OWNER L V7 7/ /Z'N, TELEPHONE i2 1/� i/ G o m <br /> C.HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER •N� ROAD NAME G y0 `Z'_4— <br /> WYa 14 345-yo-0 LEGAL DESCRIPTION (see tax receipt) . / _ / - <br /> 6A�Z P112 1,111 lV \ <br /> C. <br /> CONTRACTOR F p <br /> 'm L <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> SANITAR4: tr' PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION —�' <br /> Z <br /> � <br /> STRUCTURE/ADDITION USE: 1 ✓ , lArt �I (j <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) _S&'143 r <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) p 3 <br /> ,n P v <br /> n o <br /> 1. All required dimensions or distances to be shown or drawn to scale. m FL <br /> z <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB)and indicat m , <br /> North (N). U) <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) building(s)to center ine of <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or iver. s <br /> 4. Show the location of the well (W), septic tank (ST) and drainfield (DF), and all distances to buil Jings, w <br /> roads, lake, lot lines. n, <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 a <br /> signed and dated by the owner. Cn <br /> Q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. <br /> 2.N <br /> O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <br /> 3. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT s <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 O THE ` <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. . S 1 rwT��L 10 �1 �c�C4f¢•1 SO �fk'l �I� S 7J!O C4 f 0,0, <br /> 6. <br /> mrnvW DD y <br /> A a� dc" $ <br /> im <br /> 7. 9 <br /> 9 < H '2 H O O t0 <br /> N OO <br /> 8. P [ 62 m <br /> D <br /> o n $ E C <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the test of my f <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of „ y C) <br /> PP (including Yaccompanying ) g o m o <br /> all information contained in this application Includin an schedule and I further declare that I recognize o m b <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whi ther 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 ' O p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 `� <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of ft spection. <br /> B <br /> h <br /> SIGN HERE <br /> N ; <br /> G Igna re of own building contractor) (date) 0 : i <br /> o ; <br /> o : <br /> ZONING ADMINISTRATOR <br /> N N (n N N N f n <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 000000 0 <br />