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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator m _ o o <br /> APPLICATION FOR LAND USE PERMITS 5; 3. <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for th work v <br /> described and located as shown herein. The undersigned agrees that all work shall be done in Icor- <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. y <br /> n � V <br /> OWNER '� e- t„ TELEPHONE r��e- 'y.3 e o - <br /> J m <br /> di <br /> HOME ADDRESS yO/ OQdj <br /> ( fSCeJ / <br /> EMERGENCY/FIRE NUMBER ROAD NAME ✓' �N OR <br /> LEGAL DESCRIPTION(see tax receipt) E 5 E NR-) 3 <br /> { <br /> CONTRACTOR �� o <br /> � o � <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTUREADDITION �' m <br /> ^ o <br /> o <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o 0 <br /> m <br /> STRUCTUREIADDITION USE: <br /> J0� I <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> r <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. C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) p 3 <br /> T 'P rn <br /> T o £ <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 /> C <br /> North (N). ' plf�1 <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerlh te of m <br /> road, (c) building(s) measurement to the ordinary high water mark (OHWM)of lake, stream or ri ter. <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to build ngs, <br /> roads, lake, lot lines. <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 x <br /> signed and dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION E- <br /> FORE A PERMIT CAN BE ISSUED. <br /> 2. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERM <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELI E. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 9 <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 /> f <br /> 6. <br /> Corn MCor D a <br /> 7. m F 1 fff a $ 31 <br /> ; <br /> TN 9 <br /> 8. m <br /> o : ac C <br /> m m . <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my -44 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and acc uracy of E „ m r"n i G <br /> om o : <br /> all information contained in this application(Including any accompanying schedule)and I further declare that I rocognize <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whetl ter 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 infonna Ion I am 0:: o <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Ins pection. m !^ [ <br /> _ <br /> SIGN HERE `w V4'_ <br /> N ; <br /> (signature of owner or building contractor) (date) o <br /> o E E <br /> ZONING ADMINISTRATOR <br /> N N(n N N N Mm <br /> N m <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 0 0 o m <br /> 0 0 0 0 0 0 0 o y <br />