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67� e p/ <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator GO w _Vi o <br /> APPLICATION FOR LAND USE PERMITS d 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit fort the work <br /> z s <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- '3 <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. H m <br /> OWNER X/'CAa" - T� TELEPHONE���,—75S <br /> �l 10IG d <br /> HOME ADDRESS 'O r0USE <br /> EMERGENCY/FIRE NUMBER9' 2 20 ROAD NAME <br /> a� J <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CONTRACTOR rO <br /> e � o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE <br /> orl ADDITION 0 »- <br /> N O <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: �Pbe, `Jt(LIJ <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. In <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) A 3 <br /> a <br /> O 3 cn <br /> c <br /> 1. All required dimensions or distances to be shown or drawn to scale. 0 o i 7C <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB) and indicate m <br /> North (N). w <br /> 3. Show dimensions in feet of the following: a building(s) ( ) g( ) m <br /> ( ) ng(s)to all lot lines, b building(s)s to centerline of <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 Ri <br /> signed and dated by the owner. _ v <br /> > g <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION E- ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> S' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT; o <br /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMI <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELIll, E. 70 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 70 ? <br /> PERMITTED. A " <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF HE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. � <br /> 6.7. j <br /> ymvrnr DD y <br /> o,c �. d m <br /> 2. <br /> Q <br /> 8. Z E " rn : <br /> P m <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the bes of my O <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accu acy of I ` N O <br /> all information contained in this application(including an accompanyingschedule and I further declare that I re o nize ' i : oe o <br /> PP (� 9 Y 1 9 o m 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 /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Infonnati in I am p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other . <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of insp ictlon. m v y <br /> R N <br /> SIGN HERE 4A <br /> N ; <br /> ( na re of ow r bul ng contra r) (date) <br /> ZONING ADMINISTRATOR ` o <br /> Fn��"MacnT <br /> N N <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N N N 0 m <br /> O V 7 N O N N U 7 O <br /> O 0000000 rn <br />