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00 Cemv, <br /> Burnett Coun•y 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator y 0 0 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work -0 0 <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- 0 <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> ).�tj V <br /> OWNER ,r b rOi.c� l� TELEPHONE /$-��_ j'�Z� o (q m <br /> HOME ADDRESS 2-9'�-7/, e24N� aR.� Lr>,Nr /'�O. *7V <br /> EMERGENCY/FIRE NUMBER aqG771 ROAD NAME CiZAtl 2,wi <br /> 1 <br /> LEGAL DESCRIPTION(see tax receipt) di <br /> CONTRACTOR SGT p J! <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ) GARAGE/ CCESSORY STRUCTURE ADDITION 0 <br /> W 0 Z <br /> o r <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION <br /> C1 <br /> �7 0 $ y <br /> STRUCTURE/ADDITION USE: R �(�`(,'I-P I /X 4S l ~ <br /> (HomelCabin;C6mmercial Business; Bedroom;Deck;etc.) � <br /> YrT <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR ^ W <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> h <br /> In a 0 y <br /> ,n Z c <br /> 1. All required dimensions or distances to be shown or drawn to scale. m ° �) <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB)and indicate <br /> North (N). m o Rl <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM) of lake, stream or river. x <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildings, v <br /> roads, lake, lot lines. <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. <br /> �I <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be T 0 x <br /> signed and dated by the owner. D n <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- 0 <br /> FORE A PERMIT CAN BE ISSUED. t� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> UI <br /> CONDITIONS OF PERMIT: Z I� <br /> O r: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT � <br /> ISSUANCE. L' Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY P <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 /> f <br /> 6. <br /> CO <br /> � ' '• 'N x <br /> 8. P — m <br /> acE C <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my S ` m E m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ` f �„ $I O <br /> om o : <br /> all Information contained In this application(Including any accompanying schedule)and I further declare that I recognize (I o a g , <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether 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 information I am [ 0: pp <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other F ' <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. ,mi i i i <br /> SIGN HERE <br /> (signatufFaf owner or building contractor) data) ? i 0 : <br /> ZONING ADMINISTRATOR 1 '11VI )I/JI�I ` g '• <br /> -n <br /> JNaogNiNaom <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 o o o rm/f <br />