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V t •" 1 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Adminis ratorm 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> z <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the, work N C7 <br /> described and located as shown herein. The undersigned agrees that all work shall be done inaccor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other o cQ <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. N d <br /> OWNER .1//t�)/'f./i �Je�' TELEPHONE 8'` y�ya 'a v <br /> m <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER / - O A .-• ROAD NAME <br /> PAO 4? <br /> LEGAL DESCRIPTION(see tax receipt) O a-mSQ4 <br /> G ZPI .4 1 <br /> CONTRACTOR1;)AZ <br /> f <br /> o+, 9 <br /> m L7 <br /> o n— <br /> TYPE OF PERMIT(S): DWELLING/BUILDINGCESSORY STRUCTURE ADDITION <br /> = r <br /> S <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION Z o <br /> 0 9 <br /> m <br /> STRUCTURE/ADDITION USE: e_ Q <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 C R <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> O <br /> x <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> O 3 <br /> T P fn — <br /> 'n o g� <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 m o tN <br /> North (N). to <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) building(s)to centerlina of in <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM) of lake, stream or river. <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 mus be r <br /> signed and dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE <br /> -FORE A PERMIT CAN BE ISSUED. <br /> o O <br /> 2. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: q <br /> N <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 F <br /> PERMITTED. <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 /> f <br /> 6. <br /> D Dv 17 <br /> m 2. cu 00 m <br /> — alde M <br /> 7. $ < cyo3 <br /> 8. o F = i ! ?!rn <br /> if'n t7 n m <br /> o : u <br /> Q : C <br /> o <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the bes of my ' L7 f <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of �[ E i•"„ mom„ O <br /> all Information contained in this application(including any accompanying schedule)and I further declare that Irecognize 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 /> 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 n [ o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances c r other 3 2 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of insp ct!on. m m <br /> SIGN HERE _-, � �`7ZLL!/�'SQ <br /> (Ina�re of ow or ullding contractor) (date)of ow or ullding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED 6 N N 0 0000N N N N m <br /> .0 pt o <n cn !n o000m <br /> 0 <br /> 0 0 0 0 0 0 0 o N <br />