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on 6"Pl <br /> Burnett County 7410 Co:Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator d o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work y <br /> described and located as shown herein. The undersigned agrees that all work shall be done inaccor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other - o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y m <br /> n7 c <br /> OW ER h /c .� �� �C�r o m <br /> TELEPHONE-71�_ S6 ".3 a /S o <br /> HOME ADDRESS ay�� PaI�G�k rt ,eo4d� PO . 9&,y fJ 4r r' 9- <br /> y <br /> EMERGENCY/FIRE NUMBER ROAD NAME // S x'30 <br /> /��A/'44un <br /> _o i esrrl Vo /, 7p1s. iia <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR Qurrlef't C°a • I <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING nnR/U�77LL/LS G <br /> 0 y <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: � )2 C 0 ' <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> r <br /> o _ <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE CR _ <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> T P m <br /> T o a <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 y: <br /> North (N). U) FT <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerlini.of m 11 , <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 buildings, Z <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 musl be �jr e <br /> signed and dated by the owner. J rn <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION B-=- a <br /> FORE A PERMIT CAN BE ISSUED. _L <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERM[ <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. <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 /> 6. <br /> mmvrnr DDOy <br /> 7. m of M <br /> m <br /> m m <; : on <br /> 8. <br /> O : 2C C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the besi of my [ <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of E N d N E p <br /> all information contained in this application(including an accompanyingschedule and I further declare that Ire recognize oro o <br /> PP ( g Y ) 9 ; <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining wheth i to is- ohoo , o <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this informati n I am 0 o <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. <br /> SIGN HERE <br /> N ; <br /> (signature of owner or building contractor) (date) o <br /> 1 I o f E <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N N N N N 0 m <br /> ouvouv � m <br /> 000booboo <br /> 0000000o (A <br />