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Burnett County 7410 Co. Rd.K, No.102, Siren,WI 54872 Office of Zoning Administratorw o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 = <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work g <br /> described and located as shown herein. The undersigned agrees that all work shall be done in accorCD <br /> - <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Co ,and with all oth 3 0 <br /> applicable County Ordinances and the laws and regulations of the State of Wiscons' <br /> OWNER /,0� 0 7--'G TELEPHONE 7� �.-7 71 w 'm <br /> CD <br /> HOME ADDRESS 4/0(!O ST'6�C- 901D t_/� v <br /> - I ' -7 �MCi/1� LOT S-/e7o/ � <br /> EMERGENCY/FIRE NUMBER �/��� ROAD NAME .5'—/ 4T T �f w f� 7 � <br /> r r 1 /V `R <br /> LEGAL DESCRIPTION(see tax receipt) r3 60' I {� <br /> CONTRACTOR a 39 /b 3v O X3700 Lor#1 GSA v ' 9 Z�L <br /> /UDA�F o <br /> cu 17 <br /> 0 o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION < <br /> N O <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT / SU }VISION� <br /> STRUCTURE/ADDITION USE: C, $PnJsli 4 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) Q <br /> I <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O ` <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> O 3 <br /> m 'R m <br /> 1. All required dimensions or distances to be shown or drawn to scale. 0 o a <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB) and indicate m S. <br /> North (N). N G <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) building(s)to centerline of m oO <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. t <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildings, W (� <br /> roads, lake, lot lines. JT <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 C <br /> signed and dated by the owner. W � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE J <br /> FORE A PERMIT CAN BE ISSUED. p <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. I n <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 SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Z <br /> PERMITTED. (� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE 'I <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. e 1J <br /> 5 /Q /alp huh /Vo-t' T <br /> 6. _ N� iozl►•k ��.� 12c�or �I / ��t..,p A+e`t -ro 6� <br /> Cnfn� W 8 8 a m <br /> 7. V� OM M cv '. > Ci F m <br /> m m <br /> o <br /> s. JUN BUR 998 ,/ N c)a m <br /> NETT- ` o : iu <br /> o ; ac : <br /> m <br /> I declare that this application (including any accompanying schedule) has been examinedA IM est of my NZL7 <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the it and accuracy of m i p <br /> CA <br /> all information contained in this application(including an accompanyingschedule and 1 further declare that I recognize <br /> o 0 0 <br /> PP ( 9 Y ) 9 o m o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- o : 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 O o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other i 3 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T i D m <br /> N <br /> : <br /> SIGN HERE <br /> is n ture of owne bullIpIng contractor) (date) o <br /> ZONING ADMINISTRATOR \ l?! o '• <br /> �NNNNNNfIi m <br /> TOWNSHIP PERMITS MAY BE REQUIRED m <br /> 1 00000000Ul <br />