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Burnett County 7%10 Co. Rd. K, No. 102, Siren,WI 54872 Office. 'oning Administrator co ' o <br /> APPLICATION FOR LAND USE PERI fts' z 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- m g <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. <br /> OWNER r�� >TZ TELEPHONE v <br /> HOMEADDRE59 1;7e) p (� ,/ / L tN� l/ �/` /LG / YV✓� 1 <br /> EMERGENCY/FIRE NUMBER J ! V ROAD NAME <br /> LEGAL DF,SC I�P�TION(see tax r�ceipt). _ Q 710'0 �JS/h VS� 23-:? NW/✓LC� df} •/LAS' <br /> CONTRACTOR 9 /Y <br /> g <br /> a _ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING- GARAGE/ACCESSORY STRUCTURE—ADDITION- <br /> 0a <br /> 0 <br /> o ^ <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION T <br /> oa° <br /> m <br /> STRUCTURE/ADDITION USE: <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. <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 rn <br /> T o a <br /> 1. All required dimensions or distances to be shown or drawn to scale. <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB) and indicate C �} 45. <br /> o <br /> North (N). m <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. K <br /> rE_ <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 r <br /> signed and dated by the owner. J L5\ Cn <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- = <br /> FORE A PERMIT CAN BE ISSUED. <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <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 ? <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE <br /> 5. <br /> OHWM OF L ES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> � of <br /> Q� /, Ia lob 0 �r s'qti� <br /> 6. Olaf JZ, G(j <br /> 7. � Z : 0 c0,5' M <br /> a a c i 0 o nm <br /> Z f <br /> P — <br /> 8. o f a a ` 0 <br /> 91 m m <br /> o M <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 I am responsible for the detail and accuracy of N m N G <br /> om o : <br /> all Information contained in this application(Including any accompanying schedule)and I further declare that I recognize b : c , <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ' : o <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Information I am [ n v <br /> providing in this application. I agree to permit county gfncials charged with administering county ordinances or other3 ? 9 : <br /> authorized person to have access tope above describ9oprepises at any reasonable time for the purpose of inspection. T ; ? m <br /> m N <br /> SIGN HERE _ e, <br /> ( gna a o&Vner ng contractor) <br /> E E e E <br /> ZONING ADMINISTRATOR <br /> m <br /> TOWNSHIP P ITS MAY BE REQUIRED )� SNn Sn o N n gn o m <br /> Ll:s 8888888N <br />