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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator w - 6 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- a <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. H m <br /> OWNER ^r Z TELEPHONE <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CONTRACTOR <br /> U0 <br /> Qj D o <br /> �^ <br /> TYPE OF PERMIT(S): DWELLING/BUILDINGGARAGE/ACCESSORY STRUCTURE ADDITION 0 <br /> N O <br /> O <br /> SANITARY PRIVYFILLING/GRA ING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: O YLL�L W/ Laic-,.4e <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. T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 <br /> ,n 9 N <br /> T o n <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 <br /> North (N). m ' m <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. 0 <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildings, <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 <br /> signed and dated by the owner. w <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. <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 �. <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 ? <br /> PERMITTED. n <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 /> f <br /> 6. <br /> me mw F m <br /> 7. n 9 z . d o o ; <br /> �o <br /> = <br /> o - m <br /> rn : a7 � E O <br /> of <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my � m : , m m <br /> knowledge and belief It is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of ' O <br /> om o : <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize i <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin 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 1 am <br /> N i <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other , 3 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. m w E <br /> SIGN HERErp <br /> Isignaatture'off mneror(.u�ildingco rector) t, _�l._.___ <br /> • <br /> ZONING ADMINISTRATOR uIne !? '• ! (qyy ' <br /> N+NNfTNNNUi m <br /> LL; <br /> rT rri O rrfT N O <br /> TOWNSHIP PERMITSREQUIRED-45 <br /> EQ UIED� <br /> 000 8 0 0 0 rmA <br /> V�ilt O <br />