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6 c <br /> Burnett County 7418 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator u ; o 0 <br /> APPLICATION FOR LAND USE PERMITS 3, <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work � H <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- 3 C, <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. <br /> n <br /> OWNER TELEPHONE <br /> HOME ADDRESS <br /> lir kL,r„ <br /> Q 7�N <br /> EMERGENCY/FIRE NUMBER ROAD NAMECJ 866/91 t� iC <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CONTRACTOR �7 �1 ✓� <br /> 54 it Cf Lok-j l �iLj4ya (6ta c' <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING_GARAGE/ACCESSORY STRUCTURE-ADDITION- <br /> 0 <br /> TRUCTURE ADDITION <br /> N o U <br /> SANITARY PRIW FILLING/GR4DING CAMPING UNIT SUBDIVISION <br /> II II I�MJI I t(n o a tT <br /> STRUCTURE/ADDITION USE: i <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. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> -n a <br /> T v y <br /> T <br /> 1. All required dimensions or distances to be shown or drawn to scale. 5 9 <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB) and indicate m — o <br /> North (N). <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) building(s) to centerline of m <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. s <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 F <br /> signed and dated by the owner. ( Cn <br /> 8 <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: v <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. d <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY S (S- ? <br /> PERMITTED. —U 9 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. N <br /> 5. <br /> sc�/ bacl� avern�� -used. /� <br /> 7. o� - C MA. a� $ � m <br /> i� <br /> 6. ten; E�r� i,r� ��i� o f 5 TN <br /> 'E : <br /> �C o <br /> o . OR C_ <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my O f <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of N m ,d'„ O <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize o o <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- <br /> o : o : <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 0: <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 ' 2 <br /> authorized person to have access to the above described pre2mises at any reasonable time for the purpose of inspection. qm ? � ? y E <br /> SIGN HERE — 3/—q(_1 <br /> N ; <br /> (signature of owd r or dl cwwwaaarrnaa c (dote) o f E <br /> ZONING ADMINISTRATOR 16-1 <br /> o ' <br /> rp <br /> N N f n N N N <br /> TOW SHIP PERMITS MAY BE REQUIRED o u u O v v v <br /> g $ 00000 <br /> 00000 <br />