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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator ,�' 0 0 <br /> APPLICATION FOR LAND USE PERMITS E o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work v H <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- mFL <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other 3 0 <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y <br /> �' c � <br /> OWNER _T / G TELEPHONE �!.'�7 7�/ l <br /> HOME ADDRESS L I <br /> EMERGENCY/FIRE NUMBER [f <br /> �2 7a ROAD NAME ( 614,1611a <br /> oa1dfes <br /> LEGAL DESCRIPTION(see tax receipt) O 3/ 1.Srn O 1 <br /> CONTRACTOR �. D )� I P_ v <br /> 0 � <br /> p 0 \1lJ <br /> TYPE OF PERMIT(S): DWELLINGBUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ? `_ <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o0 <br /> STRUCTURE/ADDITION USE: L7_0 N Q <br /> (Home/Cab <br /> in; Comme tial Business; Bedroom;Deck;etc. <br /> r <br /> o_ <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 /> 'n Z a <br /> 1. All required dimensions or distances to be shown or drawn to scale. m o <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB)and indicate y <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. C a' <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildings, 0V� <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 G <br /> signed and dated by the owner. _ Cn <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> 2. <br /> o _ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: C�f <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ` I� <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. D <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. v <br /> M g c 9 u �a F m <br /> K <br /> = _. m <br /> 7. 7g <br /> Imps NN : `z C' '0 <br /> Z f _ '-! ti <br /> 8. ' <br /> 62i m <br /> Si iii ` C <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my ` '• y in <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> om o : <br /> all Information contained In this application(including any accompanying schedule)and I further declare that I recognize b m o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- <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 : 2 ; <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. ? i H <br /> ��� <br /> SIGN HER <br /> ( gnat ra of owns r ullding a Vactoq <br /> (date) S <br /> o ; <br /> ZONING ADMINISTRATOR ^� ' ' '• <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 o m <br /> SS00S 00 <br />