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eo ( d6 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator w „ -- 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 W <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 in <br /> -� <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y w <br /> OWNER �tOM� 0r Aw i�/7� TELEPHONE 6� z Z Z° ��2 2 0 <br /> 71 ��-a.L A, r-WO/G'' Z -S.7I 003 �y w <br /> HOME ADDRESS A./L , <br /> EMERGENCY/FIRE NUMBER ry�/�/�C• �T V ROAD NAMEnC6A4 �pD/�,TT <br /> LEGAL DESCRIPTION(see tax receipt) ^O <br /> CONTRACTOR <br /> 0 <br /> n o <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION <br /> y y V <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION v <br /> I/J ar `' l,'1 o v <br /> STRUCTURE/ADDITION USE: ` am + G ^ �4hSe 1 - Clq�y <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) v 1 <br /> r <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE R <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 <br /> m p cn <br /> 1. All required dimensions or distances to be shown or drawn to scale. o a <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings (NB)and indicatem y: <br /> North (N). C w <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) building(s)tocenterlin of m <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or riv r. <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildi gs, <br /> roads, lake, lot lines. <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. C <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans muse <br /> signed and dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION B <br /> FORE A PERMIT CAN BE ISSUED. <br /> o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. CD <br /> CONDITIONS OF PERMIT: o <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 SHORELIN7�. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY F <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 /> rjiAl�tC,b M6TDR f/r/sKE /fres SELF C<>,V7-^lNeffE.3r,�f <br /> wASrc��fT� Mo&jrWq MAJICS /Al oG G 17w/< N-r '6. sco� is <br /> fF/19.Z A 'f r R/oBresfccy 'FyR F Sc7dTiC . <br /> 7. FOR KV Arty PuMP� u,pvwiR$ wMa <br /> LE7 j�7pS /tiQ6 /¢TTiFCH� f,Qd/Lf/'fD.l NG L/4KESffaiP y c <br /> <. <br /> -': m <br /> 8. p{ _ j P-Q i <br /> m <br /> nSi C_ <br /> m W ; <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best f my ' G) : ' � <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and occurcy of p <br /> all information contained in this application(including any accompanying schedule)and I further declare that I rec gnizeo m o <br /> o , of <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whethe to Is- - i <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this infonnatio i I am p <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other 8 <br /> 3 : x . <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inape tion. <br /> m <br /> SIGN HER �• /�OO'k-' (�(�`1� r' �,.4 a ~ y <br /> (signature of owner or building contractor) <br /> II / I Cf1 i i o i i <br /> ZONING ADMINISTRATOR �� I UAV <br /> 1 <br /> J_: 1 eVl f9 d1��r.q fA� TI <br /> . 11 i. 0 " Mu, W N <br /> TOWNSHIP PERMITS MAY BE REQUIR . ,,'I <br /> . On ON P . olN0m <br /> O <br /> oo $ oogooN <br /> T�-Tf <br />