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cvmpj <br /> Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator vc ` H o <br /> APPLICATION FOR LAND USE PERMITS d <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work c y (� <br /> described and located as shown herein. The undersigned agrees that all work shall be done in accor- <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 /> I/ 1 1 � <br /> OWNER G.EQ f"I I' L (AftO� rJ f/J. i / IT/ELEPHONE ��� 27- <br /> 4/9D;? p <br /> HOME ADDRESS/ / / U / � I/l U vl t/l c` Lq K 2 (� o CA l L,l „(�/I /7 <br /> EMERGENCY/FIRE NUMBER/ /16 O eq ROAD NAME �V(dJf`N vl� J I6 <br /> LEGAL DESCRIPTION(see tax receipt) Par c i L C ip Y'1-. 1 d ? O,�)S >'C . 7 <br /> CONTRACTOR S ' o Qj <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTUREy ADDITION 0 C <br /> m o J <br /> 0 <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION <br /> 0 <br /> STRUCTURE/ADDITION USE: of G CA <br /> (Home/Cabin; eommercial 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. -n <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 u <br /> TZ g <br /> 1 .All required dimensions or distances to be shown or drawn to scale. F) o <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB) and indicate m ' <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. , s <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 J <br /> signed and dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- C) ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. JIN; <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 2 <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 a <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. <br /> M <br /> 7. m m ? m c �y o <br /> N p (p <br /> W O P-Q : <br /> Z f o _ cn <br /> 8. P — m <br /> N 2 <br /> g ; Via , C <br /> o <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my � G)E <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of O <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 relied upon by the County of Burnett Wisconsin in determining whether <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 O p <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other 3 i <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> N <br /> SIGN HERE �" S — w N <br /> (signature of owner or building contractor) (date) E $ E <br /> ZONING ADMINISTRATOR \'Irn����� <br /> Fn tn�fn fn ra x' 11 <br /> NNtnNNNtn m <br /> TOWNSHIP PERMITS MAY BE REQUIRED c o c c o c c o m <br /> 00000o0o f/1 <br />