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0) WYNP, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator d m o 0 <br /> APPLICATION FOR LAND USE PERMITS w 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work N <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- m ` <br /> 3 B <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 WCD <br /> i c nSIN <br /> � e <br /> 1 �l /) f <br /> OWNER Q� I.Q4� Uri (�P� h j p TELEPHONE ) (�_ !N 0 <br /> r I II�� kL ll 1 ff'' WJ a4 S011 �I 1 _ <br /> HOME ADDRESS 3z I�St�/� 1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) LOT 1 © (�1��} L ur d I-t <br /> CONTRACTOR 1 'G I✓I n <br /> v <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION o `. <br /> � r <br /> N o <br /> o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION v <br /> 00 <br /> 1 C m <br /> STRUCTURE/ADDITION USE: TAI Irl 4� <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. O 0 <br /> z g <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O21 3 <br /> 1. All required dimensions or distances to be shown or drawn to scale. 0 ? Cr <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB)and indicate m N: <br /> North (N). In ° y1 <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. t7 Z <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildings, Ul <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> N <br /> 0 <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 a <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 /> m m v m r D D7. v <br /> o6.c <br /> <, . <br /> < O O f0 <br /> �. lD O <br /> 8. o F ` �! <br /> s E 70 <br /> rn . a . A <br /> n • <br /> o f CL C_ <br /> CD m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my o: : : m; m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of E 9 a A t7 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I 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- 0 : o <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 n p <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. n IDy <br /> N <br /> tau <br /> -q� w <br /> SIGN HERE <br /> (signatupfi of owner or building contractor) (date) o <br /> ZONING ADMINISTRATOR V J(n r ) <br /> tntnf»�tntncnj' In <br /> -• NNtTn (n m <br /> TOWNSHIP PERMITS MAY BE REQUIRED � " " o" " `" m <br /> 00000000 <br /> 00000000V) <br />