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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator iu _ o 0 <br /> APPLICATION FOR LAND USE PERMITS w 3. <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 in actor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other 3. <br /> 0 <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. H m <br /> i <br /> OWNER �a h �F+�� ��fl J � TELEPHONE <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER / ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) LU ( �� V 1 <br /> CONTRACTOR <br /> 0 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING RAGE/AC ESSORY STRUCTURE���//' ADDITION oma-' <br /> y r <br /> 0 <br /> 0 <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION- <br /> STRUCTURE/ADDITION USE: as � &t4 <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 /> 0 Ir J <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 <br /> T F (n <br /> T o <br /> 1. All required dimensions or distances to be shown or drawn to scale. 5 <br /> 2. Show the location and size of all existing buildings(EB) and all new buildings(NB)and indicate m <br /> North (N). to = (� <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of m <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. <br /> 4. Show the location of the well (W1), septic tank(ST)and drainfield (DF), and all distances to buildings, ( � <br /> roads, lake, lot lines. \ ' 1 1 <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. 1 <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. v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> o. <br /> FORE A PERMIT CAN BE ISSUED. Q <br /> a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 91 <br /> o <br /> CONDITIONS OF PERMI <br /> o <br /> n <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 SHORELINE. <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. [`1 <br /> 5. <br /> f <br /> 6. <br /> QQ� 3� � $ m <br /> 7. ry< � CN5' S <br /> O <br /> = Fes : Tom : 1 <br /> 8. o may : 7g <br /> m <br /> � • A <br /> Ss <br /> o nom . <br /> m m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ` E m <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy ofp, y `('„ ? O <br /> all information contained in this application(Including any accompanying schedule)and I further declare that I recognize : Pm o : <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to i S E $ f <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 O p [ <br /> providing in this application. I agree to permit county offs charged with administering county ordinances or other <br /> authorized person to have access to the above despribed,0remighs at any reasonable time for the purpose of Inspection. <br /> SIGN HERE <br /> of owner or ng contactor) (ana) o <br /> o i <br /> ZONING ADMINISTRATOR <br /> 0 <br /> M <br /> N N N N N N N m <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N O n u, 0 O In <br /> 000$ 000g U) <br />