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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Adm nistrator m m o O <br /> APPLICATION FOR LAND USE PERMITS w 3• — <br /> 0 <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 accor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and wi h all other - o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y <br /> OWNERTELEPHONE G/a 567 a�31 <br /> J�Dearne e PRN�s d <br /> HOMEADDRESS 7111 7UV6 110d Na 6eeoIZLyN LIENfG/1 �`✓lRj SSy. J I <br /> _ I <br /> EMEKGenoviFlac NUMBER �87�o6i ROAD NAMEE/9S/ '/��t �y�ie� U <br /> y�9I<!53 <br /> LEGAL DESCRIPTION(see tax receipt) /"T G,w e O <br /> 1 (� <br /> pal g g0161A10 . olgoo ZwO RDD OAROuNS 6odAtZ <br /> i �s nor q <br /> CONTRACTOR <br /> v <br /> g <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTUR ADDITION o <br /> N 0 c` <br /> O (� <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION j <br /> Z $ <br /> m <br /> STRUCTURE/ADDITION USE: GAR R'U7 1 <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. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) p 3 }� <br /> -n P N <br /> T Z v <br /> 1. All required dimensions or distances to be shown or drawn to scale. n P o, <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings (NB)and indic to m y <br /> North (N). m ' <br /> 3. Show dimensions in feet of the following: (a) buildings) to all lot lines, (b) buildings) to cent rline of `1\ <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. j a <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. 2 <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans Tiust be <br /> signed and dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> o j <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: oJj <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 � <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> F <br /> 6. <br /> mrn V rnDD y <br /> 7. oa m <br /> m <br /> m yo' 'z P_Z <br /> 8. ' ` rn <br /> � D <br /> C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the, best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare th <br /> at I recognize( :) 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 or other 3 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE <br /> N ; <br /> (signature of owner or building contractor) (date) o <br /> ZONING ADMINISTRATOR )rnCialiIPn <br /> EA���FA�FA� T <br /> -+ NNN NNN (n m <br /> TOWNSHIP PERMITS MAY BE REQUIREDo v, o u, o m <br /> 00000000 <br /> 0 0 0 0 0 0 0 0 N <br />