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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administratord o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for thework o <br /> described and located as shown herein. The undersigned agrees that all work shall be done in occor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with alllother 3 <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y m <br /> OWNER nQ^� �i/�tk� y�1J12'k Mao se-,- <br /> HOME <br /> iJ /7 "I I/1 w <br /> HOME ADDRESS ,S/ 7oZ �3 y C u <br /> O , ya MN SS37Fl � <br /> (— <br /> EMERGENCY/FIRE NUMBER ROAD NAME /� l <br /> C l.0/c.k ROAc>✓ I . <br /> LEGAL DESCRIPTION(see tax receipt) 9ariel e6 L "`•Fed i" y w y-n triyT 1&r- IV-- Sc�rl•w <br /> 77 <br /> CONTRACTOR sE�� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING nn( anr_Gan <br /> - ...CCESSORY STRUCTURE ADDITION o ,. <br /> r <br /> I N O <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION- <br /> STRUCTURE/ADDITION <br /> UBDIVISION STRUCTURE/ADDITION USE: Gc� Sja/w.0 T <br /> 1 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) i <br /> ! r <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE O o <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> T P Co <br /> 1. All required dimensions or distances to be shown or drawn to scale. p o n <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB) and indicate C o <br /> North (N). 0 <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline f m I <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or rive . (Sl <br /> 4. Show the location of the well (W), septic tank (ST)and drainfield (DF), and all distances to buildings', 5U <br /> roads, lake, lot lines. S <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. I { <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must <br /> signed and dated by the owner. <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE <br /> FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PER I Io Jl <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE 7 NNN <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY z <br /> PERMITTED. $ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF TH� <br /> 5. OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> i <br /> 6. <br /> f <br /> 7. <br /> I 2. $ m <br /> 9 <, N, '2 N O J rp <br /> 8. c F i T [ <br /> i to ci 2 m <br /> D <br /> ate : C <br /> mni . <br /> I declare that this application,Including any accompanying schedule) has been examined by me and to the best o my � ' ; �� ; m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuse of v, - <br /> all information contained in this application(including any accompanying schedule)and I further declare that I curecogiz f o o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether t 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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances oro her <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspecti <br /> SIGN HERE '' f . . <br /> Ign uro of own ullding contractor) . ' i ' i <br /> E <br /> ZONING ADMINISTRATORRim <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N O N N N O m <br />