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C p/ <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Adminis rator o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit forthwork H <br /> described and located as shown herein. The undersigned agrees that all work shall be done in ccor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with al other o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. a p <br /> c v E <br /> OWNER A t! TELEPHONE <br /> HOME ADDRESS 66 tJAJ 44 Q/d Xj O <br /> EMERGENCY/FIRE NUMBER /3 ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) 1 1 Oe . l <br /> CONTRACTOR SE! <br /> TYPE OF PERMIT(S):DWELLING/BUILDING G RAG ACCESSORY STRUCTURE /` ADDITION y O <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION o v 9 <br /> ff <br /> STRUCTURE/ADDITION USE: 0- <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 CR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) A 3 <br /> O v c-Y <br /> 1. All required dimensions or distances to be shown or drawn to scale. o s:1;< <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 centerlin 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 (W), septic tank(ST)and drainfield (DF), and all distances to buildirgs, <br /> roads, lake, lot lines. <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. Q <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans mus be <br /> signed and dated by the owner. J <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION B - (A ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT a <br /> ISSUANCE. Irb <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF TIHE <br /> OHWM F LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. d(�lyz 1041m I-'/-' A-1 1 zre S`tirti 3°�t <br /> 6. <br /> 0)(n DD <br /> 7 0, c c. <br /> J <br /> 6. o _N <br /> m <br /> 1 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 accui acy of 00 ' i �'o y ; O <br /> all Information contained in this application(includingan accompanyingschedule and I further declare that I recognize 1. '12 0 : <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 I am . O p <br /> providing in this ap on. I agree to permit coup officials charged with administering county ordinances oi other <br /> authorized perspplo ha3b access to t,4 above s d premises at any reasonable time for the purpose of Inspection. m E <br /> SIGN KE <br /> to <br /> (signature of ow or or building contractor) (data) <br /> ZONING ADMINIST TOR f o <br /> y <br /> TOWNSHIP PERMITS MAY BE REQUIRED C o m�v o N a b o m <br /> ooSgo 000rn <br /> 7 TTT^T�R <br />