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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator - -- o <br /> " APPLICATION FOR LAND USE PERMITS d <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work � H <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. w <br /> � v <br /> OWNER Y01N 2 TELEPHONE _ ,�8 y _ <br /> o m <br /> `t /)'I af_ 1 e e3 m t <br /> HOME ADDRESS n <br /> P o 1.k IAS — . <br /> EMERGENCY/FIRE NUMBER C ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) f '� \' S oda. a <br /> CONTRACTOR <br /> o <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION 0 <br /> y r <br /> o � <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 3 <br /> STRUCTURE/ADDITION USE: o m C <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> CT <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE C R <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 <br /> T P vi <br /> 1. All required dimensions or distances to be shown or drawn to scale. o a <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB) and indicate m N: <br /> North (N). 0 = <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) building(s)to centerlin of m <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or ri r. <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. u�J <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 musl be 0 K <br /> signed and dated by the owner. u <br /> 1 � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION B <br /> FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. -F— <br /> CONDITIONS OF PERMIT: o <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 SHOREL]h E. <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 HE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> 6. p <br /> oc� �m $F m <br /> 7. <br /> M <br /> N W d Cin O_ <br /> Me N O ? FZ <br /> c� m <br /> o f E y o p <br /> Oi i >7 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the bee of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and OCCL acy of p <br /> all Information contained in this application(including any accompanying schedule)and 1 further declare that I rec ognize o o <br /> that this information I am providing will be relied upon by the County of eumett Wisconsin in determining whothi r to Is- o � <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Informed n 1 am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances c r other <br /> 3 ` ig <br /> E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Insp ctlon. mT ? m <br /> 0 N <br /> �J Win N <br /> SIGN HERE / r i_l�D'Sih,r�a—v�-v <br /> It <br /> N ; <br /> (sig urs cf owner or bullding contractor) (dote) o <br /> o i <br /> ZONING ADMINISTRATOR !•I� <br /> Ntx to�'(n fnw� �I <br /> N N N N N N N <br /> TOWNSHIP PERMITS MAY BE REQUIRED o m <br /> 00000gggfrl <br />