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NCPOV)L <br /> Bumett Ctunty 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator T o 0 <br /> APPLICATION FOR LAND USE PERMITS v 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work v y <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- m g <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other 3 <br /> v <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y <br /> OWNER7 117TELEPHONE /-6 �a-(�S�(� /��� ^p v <br /> HOMEADDRESSgoaa L do ClZf, ZNUE2 Gje#Yt /I S MN -5--S ( (� 0 <br /> EMERGENCY/FIRE NUMBER L/ ROAD NAME M ��OLIJN 1� O <br /> MC a&-3 _ a63 9 72 R/ <br /> LEGAL DESCRIPTION(see tax receipt)%C SES„( J�6T A 9-N�aS I tJ �/0 <br /> CONTRACTOR �4c,Q ��L o <br /> c AJ <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION �- <br /> N .tri <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> Z a° <br /> STRUCTURE/ADDITION USE: N C !!O$ / 4g — :5'b ! <br /> bin; Commercial Business;Bedroom;Deck; _ <br /> r <br /> 0 <br /> PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR W <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 <br /> -n p <br /> T O Cr <br /> 1. All required dimensions or distances to be shown or drawn to scale. <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB)and indicate m OH <br /> North (N). N cx_�' <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) building(s)to centerline of m 1 VtA <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. Id 0 <br /> Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildings, <br /> roads, lake, lot lines. 5U <br /> Indicate if a walkout basement is planned and show areas to be graded or filled. c� <br /> i <br /> If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be <br /> signed and dated by the owner. O C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. <br /> 2' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W <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 Z <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. <br /> 5. <br /> 5. ferm ,Pec,klA �/-d <br /> M 0aM. 0) 98a m <br /> 7. m (D C Coa i 70 <br /> ID <br /> (n M <br /> 8. P fo <br /> u+ ; m <br /> : 32' O <br /> o= CLC <br /> o <br /> CD <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of i „' �`„' a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o o <br /> o , o ' <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- o . 0 . <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 n; o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 ; ig <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. {n m w <br /> SIGN HERE <br /> N <br /> v (signatu r or b itg co ate) o <br /> ZONING ADMINISTRATOR <br /> '69'69 9 ' 'I1 <br /> YOWNSHIP PERMITS MAY BE REQUIRED N N N N N N N m <br /> 0 N N 0 (n (n CA 0 <br /> 0S000 $Sorn <br />