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me�ov/ <br /> Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Adminis rator y m o 0 <br /> APPLICATION FOR LAND USE PERMITS d 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for th work y <br /> described and located as shown herein. The undersigned agrees that all work shall be done in ccor- g <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with al other - o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> OWNER J4W I .� urs N�f-)s(.� TELEPHONE <br /> �`� <br /> HOME ADDRESS �,�,�� 7'/.e „I 2 1 li,M v I <br /> GGG <br /> EMERGENCY/FIRE NUMBER ROAD NAME I [J_I - <br /> LEGAL DESCRIPTION(see tax receipt) _ ) r V/ Y 1`C� <br /> CONTRACTOR 0 N <br /> 0 <br /> TYPE OF PERMIT(S): DWELLINGBUILDING GARAGEIACCESSORY STRUCTURE ADDITION <br /> y O <br /> SANITARY PRIVY /FILLING/GRADING/ CAMPING UNIT SUBDIVISION- <br /> 0y� <br /> STRUCTURE/ADDITION USE: `'' ��'� L. L s ~ r�106 l4 o l� <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. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> -n a y <br /> 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 N: <br /> North (N). m <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) building(s)to centerli a of -L) 1 ( <br /> road, (c) building(s) measurement to the ordinary high water mark (OHWM)of lake, stream or ri er. s <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildi rigs, <br /> roads, lake, lot lines. I 1 <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 mul t be d <br /> signed and dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION I IE- <br /> FORE A PERMIT CAN BE ISSUED. N m <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 PERMIT <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 C <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> aid '-� lsa 6 <br /> • F�mr <br /> 6. � 9• n <br /> �n,ta�y Y'Crml� #lel l ompnimym <br /> 7. <br /> m R' 'Ra »N�� Z m M � <br /> »E oQ <br /> u A o M-Z : <br /> 8. N [ c 2 m <br /> 0 <br /> � � m <br /> o <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the be t of my . O <br /> knowledge and belief it Is true, correct and complete. I acknowledge that I am responsible for the detail and ac racy of i ry N G <br /> oro o : <br /> all information contained in this application(including any accompanying schedule)and I further declare that Icognize <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whet or <br /> to is <br /> E <br /> Is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Informal on I am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances Dr other 3 ? `o <br /> authorized pen to have access to the above described premises at any reasonable time for the purpose of ins action. m H <br /> SIGN HERE <br /> (slg re of owner or building convector) (date) o [ <br /> o ; <br /> ZONING ADMINISTRATOR ' `• . <br /> N N N N N N n m <br /> TOWNSHIP PERMITS MAY BE REQUIRED o `n . 0 0 o c o <br /> m <br /> oS000000fA <br />