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w cmp, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator c -00 0 <br /> APPLICATION FOR LAND USE PERMITS 2. 1 <br /> u 3. <br /> z s <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 inccor- 3 <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with al other 3 o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> c <br /> OWNER TELEPHONE o ° <br /> m <br /> HOME ADDRESS <br /> Inc S c w <br /> EMERGENCY/FIRE NUMBER ��11`) ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) 1 _ �.� I err . I golf 9->j 4\V <br /> CONTRACTOR L <br /> 0 <br /> m O <br /> 2 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION 0- <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> >C 0 O71 <br /> Z ° <br /> \ — m <br /> STRUCTURE/ADDITION USE: V/, Is r Gs 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. In L� <br /> O Ir <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 <br /> "n P N <br /> 1. All required dimensions or distances to be shown or drawn to scale. o n <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB) and indicate m y' <br /> North (N). w oma, <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) building(s)to centerline of m i <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. a <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. UI <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 <br /> signed and dated by the owner. a, <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION E- ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. m <br /> CONDITIONS OF PERMIT: q <br /> N_ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMI <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 ? <br /> PERMITTED. 2 D <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF HE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. h{� <br /> 5. <br /> F <br /> 6. <br /> 7. M o m 2 8 m <br /> N O : kt�1 : : <br /> = f TIN <br /> 8. o — <br /> D <br /> C <br /> m m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the bas of m � ' � G) <br /> PP ( 9 Y 1 Y Y " � ` ' <br /> knowledge and belief it is true, correct and complete. I acknowled a that I am responsible for the detail and accuracy of <br /> 9 P 9 P Y Nm N : O <br /> PP (including Yaccompanying 1 9 0m o : <br /> all Information contained in this applicationan schedule and I further declare that I recognize nize � b m b <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining wheth r to is- 0 : 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 : 0 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances c r other ! 3 ; x <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of insp action. <br /> m <br /> H <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) o <br /> ZONING ADMINISTRATOR I 0 <br /> N N N N N N N <br /> TOWNSHIP PERMITS MAY BE REQUIRED o u u o N u, m o m <br /> 00000000 <br /> 0 0000000 f// <br />