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X-''v) <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator w m o 0 <br /> 3 <br /> APPLICATION FOR LAND USE PERMITS f <br /> 0 <br /> TO NE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work 3 6 �. <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- C <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. a p <br /> n / <br /> c D F <br /> OWNER 6 TELEPHONE / / `� —0 'amu' <br /> HOME ADDRESS w= SY90�1 <br /> V <br /> EMERGENCY/FIRE NUMBER // ROAD NAME <br /> -So <br /> tw5-e—Itr <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CONTRACTOR . p �, <br /> CD G1 <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION ° �- <br /> � r <br /> N ° <br /> O <br /> SANITARY PRIVY FIL ING/GRADING CAMPING UNIT SUBDIVISION v <br /> STRUCTURE/ADDITION USE: n Lebo a A NrX. id X'&P1 ?ct <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <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. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> n P rn <br /> m Z <br /> 1. All required dimensions or distances to be shown or drawn to scale. m o <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB)and indicate y <br /> North (N). m 1 ' <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. C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- °_ <br /> FORE A PERMIT CAN BE ISSUED. <br /> o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: -I <br /> 3. <br /> ° <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 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 /> 6. <br /> rnWTWr- DD0 -0 <br /> ocM. 0d m a. E <br /> m <br /> 7(G <br /> N O CD`2 <br /> Z 1 ' Trn A <br /> 8. ° �9 m <br /> C <br /> I 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 1 am responsible for the detail and accuracy of �'„'mom„ 0 <br /> PP (including Yaccompanying ) recognizeoc o : <br /> all information contained in this application mcludin an schedule and I further declare that 1 o fD o <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Is- 0 : o : <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this Information I am <br /> O? 0i <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. T m <br /> N <br /> SIGN HERE FrN " _ :'' . o i <br /> gnat of owner or bull ng contactor) I r--—jiat9T"" "' E o <br /> ZONING ADMINISTRATOR <br /> iFnEnvi�Ea NCn m <br /> 9pppNn ppm <br /> TOWNSHIP PERMITS MAY BE REQUIRED m <br /> �00000000fn <br />