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em GyT <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Adminis rator m m o 0 <br /> - APPLICATION FOR LAND USE PERMITS 3. <br /> 0 <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 in ccor- 3 —) <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other o (n <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin.715 866- 7 <br /> 2 <br /> 7 On' o <br /> OWNERanll-� 7r TELEPHONE 6,a <br /> CA <br /> HOMEADDRESS 1/030 VY\ col!U � lQl� gl�, llln[i7i <br /> EMERGENCY/FIRE NUMBER ROAD NAME I 1 �onf� 1l <br /> LEGAL DESCRIPTION (see tax receipt) l '94 C7 <br /> CONTRACTOR <br /> WWW o r, <br /> � o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—e—GARAGE/ACCESSORY STRUCTURE--,I(—ADDITION 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o o <br /> STRUCTURE/ADDITION USE: d 'f San Llyy <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 CR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In r <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> Cn <br /> T Z c <br /> 1. All required dimensions or distances to be shown or drawn to scale. 5 P FL <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB) and indicate m N' <br /> North (N). 0 <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 {() r <br /> 4. Show the location of the well (W), septic tank (ST) and drainfield (DF), and all distances to buildir gs, W j <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. Cn <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION B - ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> N <br /> 2 (� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMI C <br /> ISSUANCE. a <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. a <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. Ff& Q lla"aJ -o�cc PU,&ffle,w, - MAX ftac6 30 T-t <br /> ./ f <br /> 6. '( rae-S )\ di— 410a,0A1+ Or rexwu4�,l vJd -c, <br /> O D o m d A R F m <br /> 7. e H y o 2 <br /> 9 (D O Z <br /> 8. <br /> Z f T y <br /> m <br /> o : w C <br /> o <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the bes of my L) <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accu racy of m ? O <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I rei ognize [ o o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining wheth r 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 Informati n I am 0i o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances other 3 8 <br /> authorized person to have access to the ova desc d remise t any reasonable time for the purpose of insp iction. <br /> N <br /> r-� <br /> SIGN HERE <br /> (s at a of owner or b ng contra q <br /> ZONING ADMINISTRATOR SG i 1 o <br /> VO <br /> MwW n En m <br /> TOWNSHIP PERMITS MAY BE REQUIRED L' N N P N N N m <br /> O 0 0 o 0 m <br /> J <br />