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Nc , <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator (nM 0o <br /> APPLICATION FOR LAND USE PERMITS d 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work � y 0 <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- 3 U9 <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 Q <br /> t c m <br /> OWNER A1n tie,," / ��� TELEPHONE 2l/C1�_ S`/ / n o G `= <br /> /` �-1 C� �.J 7 / �l tP¢�!q1 V I <br /> HOME ADDRESS P,0, 0 /3 <br /> EMERGENCY/FIRE NUMBER lv o9 Y J Yl ROAD NAMEUJ/ / y 70 <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CONTRACTOR SEL F r'(L 11U TSE L o <br /> C) <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE���// ADDITION o <br /> N O <br /> 0 D <br /> SANITARY PRIVYFILLING/GRADI <br /> NGCAMPING UNIT SUBDIVISION— <br /> Z <br /> C—fa-I-GtG,o /ST'S // ' 4� <br /> STRUCTURE/ADDITION USE: �iyQ �(ts XL/L/ <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. m <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 <br /> T 7 y <br /> 1. All required dimensions or distances to be shown or drawn to scale. o n <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB) and indicate m — y: <br /> North (N). C W ° <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. ] <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. <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 <br /> signed and dated by the owner. <br /> `7 2 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- (7>1 a <br /> FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. S. <br /> CONDITIONS OF PERMIT: <br /> N <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 F <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 /> 6. <br /> yy� U DD y <br /> 7. ao,c �. <br /> H 3m 7mg <br /> 5. <br /> p• N <br /> <,N, : O =tG 3 <br /> 8. o - <br /> �: .M <br /> O <br /> P-: <br /> `• C <br /> I declare that this application (Including an accompanyingschedule has been examined ' ° m <br /> pp ( g y ) by me and to the best of my , m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detall and accuracy of a V E p <br /> all Information contained In this application(including any accompanying schedule)and I further declare that I recognize o o <br /> that this Information I am providing will be rolled upon by the County of Burnett Wisconsin in determining whether to Is- o I 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 p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ' 3 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. m ? y <br /> SIGN HER � �� w <br /> (Sig a of ar Iding contractor) (da* o <br /> o : <br /> of <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED N" o N ooo m <br /> ooggo fq <br />