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NGm-tp <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator Cn o ;0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 0 <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 in actor- 3 g <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. m <br /> OWNER ST4ALbu .I,an,�s �EGt-tea TELEPHONE <br /> HOME ADDRESS <br /> 990 Shorev'ew, m iV 5-1�7a(0 <br /> EMERGENCY/FIRE NUMBER 731 3 ROAD NAME ar y GG. <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CONTRACTOR SrAUc Xg4&Ay C;o9S7�u,�T/ems o �� <br /> � o <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION 0 <br /> H O <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o ° <br /> m <br /> STRUCTURE/ADDITION USE: 1wel n2g!!! de' FAO# <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <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. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 B <br /> m � w <br /> T Z v <br /> 1. All required dimensions or distances to be shown or drawn to scale. m P a <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB)and indicate N <br /> North (N). rn <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of I <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM) of lake, stream or river. r, <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildings, S,)� <br /> roads, lake, lot lines. ll�� <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. l C <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be <br /> signed and dated by the owner. () ) rn <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- °_ <br /> FORE A PERMIT CAN BE ISSUED. <br /> 0 <br /> 7 � <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. I t ' <br /> CONDITIONS OF PERMIT: IN <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 Z <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE �- <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> 6. <br /> Im <br /> rnrn� � °DD Im <br /> o c � <br /> 7. 0 AFL P'- am n M <br /> C 00 � <br /> cm two °(0 <br /> c ° Thi m <br /> 8. a cit : Q <br /> o : m <br /> o ? M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my '• �I <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of D <br /> on o : <br /> all information contained in this application(Including any accompanying schedule)and I further declare that I rocognize o m 0 , <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 ': <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. T m 0 <br /> SIGN HERE � <br /> N ; <br /> (sig�of owner or building contractor) (date) <br /> dim <br /> ZONING ADMINISTRATOR e <br /> -+NNpi N NN(P m <br /> NNo nNnp <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 o o 0g o m <br /> 000000 o d1 <br />