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04 amp <br /> Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54672 Office of Zoning Administrator m -0o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work � y <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 Lk <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y m <br /> o <br /> OWNER TELEPHONE <br /> �Jy (/Iq IJr /Iah/ w c CD <br /> HOME ADDRESS2 ���f'�t c o J� M ?df p0 5- d <br /> C <br /> EMERGENCY/FIRE NUMBER Sa(�L/ ROAD NAME co, el)- <br /> LEGAL DESCRIPTION(see tax receipt) d 1 / I ��J� _ 1� .TL/�N y <br /> CONTRACTOR 1343 '1 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—Ci�-- _GARAGE/ACCESSORY STRUCTUREADDITION _ <br /> m O <br /> O " <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> p� /� / o 0 <br /> STRUCTURE/ADDITION USE: �ly/�fi AF6 /¢/ Rreet Arc f- ,fi3OCL,I.. <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 <br /> O 3 <br /> -n P Cn <br /> c <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 y: <br /> North (N). y 9 ° <br /> j <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, <br /> 91) <br /> roads, lake, lot lines. p <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. t <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 /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- C ° <br /> FORE A PERMIT CAN BE ISSUED. C (� <br /> o �v <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Com' <br /> CONDITIONS OF PERMIT: o <br /> N_ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. C <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 <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> 6. <br /> Cn (n 9 cn r-> > <br /> o•c =.M w <br /> 7. am $fD M <br /> m 2 y: m O Grp <br /> CD' <br /> Thi <br /> 8. oma' '• M <br /> ' cid m <br /> m m f C <br /> jdeclare that this application (including any accompanying schedule) has been examined by me and to the best of my C) . . . : m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of (`J ` E $' ,, ? ma <br /> n11 information contained in this application(including an accompanyingschedule and I further declare that I reco nize � o <br /> PP ( 9 Y ) g ? o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- E c : <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 <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. r H i <br /> SIGN HERE <br /> (a at of own r building contractor) jdate) 0 <br /> o <br /> ZONING ADMINISTRATOR ``^^' <br /> { ;1w 691fl2 rn&' In <br /> TOWNSHIP PERMITS MAY BE REQUIRE 11 N N N N N (T m <br /> 1 / DONNO fTNO m <br /> -- -- -. 000000oN <br />