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Burnett County 7470 Co. Rd. K, No. 702,Siren,WI 54872 Office of Zoning Administrator m f o <br /> APPLICATION FOR LAND USE PERMITS d 3. <br /> 0 <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 <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other 3 0 <br /> applicable Cou Ordinances and the laws and regulations of the State of Wisconsin. <br /> q n � <br /> OWNER Q l� AJ rJ ,� / TELEPHONE <br /> 5 % <br /> HOME ADDRESS C <br /> EMERGENCY/FIRE NUMBER 1n�1.m ROAD NAME <br /> 000%1JJtYYY'111 iii ii'��\1 �Tr � �1 <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CONTRACTOR <br /> � o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION 0 <br /> N Q <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> �7 <br /> STRUCTURE/ADDITION USE: /(—,n/00 S3 CY—y, //C <br /> Home/Cabin; Commercial Business;Bedroom;Deck;etc.) <br /> /—) 9 o_ <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETEOIh rD <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> � � O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> a <br /> M Z — <br /> 1. All required dimensions or distances to be shown or drawn to scale. m o FL_t <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB) and indicate — <br /> North (N). w p <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. E7 s <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildings, 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 _� K <br /> signed and dated by the owner. N <br /> 3. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- _ <br /> FORE A PERMIT CAN BE ISSUED. N <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. J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ( mb <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 /> F <br /> 6. a <br /> N co <br /> M V ' S p mm <br /> O c �.d <br /> 7. A C' <br /> 9 m' o �Z <br /> = :E T4 : <br /> 8. ° N <br /> 62i O <br /> o . ate : C <br /> o <br /> m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my m . In <br /> v <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of i i i T1 N[ <br /> oc o : <br /> all Information contained in this application(including any accompanying schedule)and 1 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- <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 <br /> providing in this applicatioy I agree to permit county officj#ls charged with administering countyordinances or other <br /> authorized person to have ytoess to the above describe ises at any reasonable time for the purpose of Inspection. <br /> e N <br /> asp- 9� <br /> SIGN HERE � <br /> N ; <br /> (signature of owner or building contractor) (date) g <br /> r '• ° C• i i i i <br /> ZONING ADMINISTRATOR ll'Y) ' <br /> ra r0 m o m <br /> PNnp c, N N mom <br /> TOWNSHIP PERMITS MAY BE REQUIRED o o ao o0 6 0'00 rn <br /> 000 $ o 0ooVl <br />