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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administratord � 0 0 <br /> APPLICATION FOR LAND USE PERMITS '-' 3 <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit fort e work y <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 1 other - o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. H m <br /> OWNER TELEPHONE <br /> HOME ADDRESS4,26 �2lki / II(, ) <br /> EMERGENCY/FIRE NUMBER ROAD NAME� !S <br /> Aj <br /> LEGAL DESCRIPTION(see tax receipt) ro`e5 _ <br /> CONTRACTOR <br /> 0 <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION 0 <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION- <br /> STRUCTURE/ADDITION <br /> UBDIVISION STRUCTURE/ADDITION USE: <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 INCOMPLET70R <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> O 3 <br /> " a cn <br /> 1. All required dimensions or distances to be shown or drawn to scale. M o <br /> 2. Show the location and size of all existing buildings(EB)and all new buildings (NB)and indicate m H: <br /> North (N). c yJ ; v ) <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s) to centerline of m I m <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or ri er. <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildings, SU / <br /> roads, lake, lot lines. I� nn V7 <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 mus be r <br /> signed and dated by the owner. I N <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. I� <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 2 Ul <br /> CONDITIONS OF PERMIT: o <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 F <br /> PERMITTED. 9 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF I HE <br /> 5. OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. CJ I <br /> f <br /> 6. <br /> (nN�(nr DD <br /> 7. a 4. <br /> XI <br /> nn V N. Z N p p <br /> ' o <br /> c� 1 <br /> n= C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the frost of my S ' C5 <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accu cy of �,'y F^„ p <br /> all information contained in this application(Including any accompanying schedule)and I further declare that I recognize o o <br /> that this Information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- I <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Information 1 am ; n <br /> providing in this application. I agree to permit county officials charged with administering county ordinances o other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspe otlon. r ': <br /> v o <br /> N <br /> SIGN HERE f 1` <br /> (signature ownefbr bul ng contractor) i (tlNa) <br /> ZONING ADMINISTRATOR nan <br /> winw�www� -I <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N N m <br /> O fp n U t O V i N N O <br /> 0 0 0 0 0 0 0 0 <br />