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.rntett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m -00 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> 0 <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- 3 <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with al other o l/ <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y m <br /> r � 0 O <br /> OWNER TELEPHONE 7/S V .�S S� �/ m <br /> HOME ADDRESSN ` ell Sp m n ti <br /> J 'F� Q <br /> EMERGENCY/FIRE NUMBER / ROAD NAME A4,5^71.4.9,A- le t <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CONTRACTOR I <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION 0 `»- <br /> m 7� <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION o o <br /> STRUCTURE/ADDITION USE: <br /> s�o del C 3 ' 3 / IW11 <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <br /> r <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE CR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) z ° <br /> 0 3 <br /> T 'oN <br /> 1. All required dimensions or distances to be shown or drawn to scale. o <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB) and indicate m y: <br /> North (N). y <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. r <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildir gs, <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 t °� <br /> signed and dated by the owner. U v <br /> �. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE <br /> -FORE A PERMIT CAN BE ISSUED. Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. (� <br /> CONDITIONS OF PERMIT: 141 <br /> 0 Z <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 p <br /> PERMITTED. 1 w <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF I HE 2 <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> f <br /> 6. <br /> mVl � (nM. W DD O '9 <br /> m <br /> 7CS Mn <br /> v m'o' o <br /> 1!° Q : 1 <br /> 8. <br /> Z `! TN: M' — ' m <br /> o m M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of N y ? a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> Wisconsin <br /> o o <br /> that this information I am providing will be relied upon by the County of Burnett sconsin 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 applicati n. I agree to permit county officials charged with administering county ordinances o other3 2 <br /> authorized person to holliAccess to the above described premises at any reasonable time for the purpose of Inspection. m i m E <br /> m : <br /> � N <br /> SIGN HERE <br /> N ; <br /> �natur caner or building contractor) (date) <br /> or building contractor) (date) o <br /> i o <br /> ZONING ADMINISTRATOR <br /> w' <br /> v <br /> TOWNSHIP PERMITS MAY BE REQUIRED o0 0 0 0 0' o m <br /> 0000 oo CA <br />