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071) 6(", <br /> 2-unett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator W - o <br /> APPLICATION FOR LAND USE PERMITS - <br /> 4 � O <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work <br /> described and located as shown herein. The undersigned agrees that all work shall be done in a ccor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other <br /> o <br /> applicable County Ordinances and the laws and regulations of the State f Wisconsin. m <br /> 0 <br /> OWNER TELEPHO ? Y a <br /> S _ 33 riS <br /> o yl- <br /> HOME <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER `� p ROAD NAME <br /> J'l <br /> LEGAL DESCRIPTION(see tax receipt) 6 ` > E r <br /> ye//dcJ <br /> CONTRACTOR o LI <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UN SUBDIVISION � <br /> o $ <br /> STRUCTURE/ADDITION USE: - <br /> (Home/Cabin; Commercial Business; Bedrom; Deck;etc.) <br /> r <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> ;a F=� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 u �N <br /> 'n o � <br /> 1. All required dimensions or distances to be shown or drawn to scale. F <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB)and indicate m9-1) <br /> North (N). I <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerli a of m <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or ri er. I r <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildi gs, O <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 mu be -O <br /> signed and dated by the owner. /bFj <br /> Cn <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION E- <br /> FORE A PERMIT CAN BE ISSUED. 2. <br /> N <br /> td <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITl C <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELI qE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY I I p <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. // Y'rnr <br /> f2, /tJb� r`c,' j1 • rn pi V rn r D D O � <br /> pp 0.1�+. y Oc m <br /> 7. N Slfe O� $i45 I� m R� <br /> V < m : `Z m O 5C <br /> iD O : ' P—Q <br /> 8. <br /> o c ff : : m�ti c>� <br /> nc <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the t of my m <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detall and ac uracy Of m o <br /> all Information contained In this application(including any accompanying schedule)and I further declare that I cognize . o m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whet er to is- ; <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this Inform Ion I am n <br /> providing in this application. I agree to permit county officials charged with administering county ordinance or other ! [ x <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of in pOction. T $ ; <br /> SIGN HERE <br /> at atum of buIIdIng contractor) (date) g <br /> O' <br /> ZONING ADMINISTRATOR ' '• � <n' � � <br /> �r e�Fn r»�e3 fn re u, m <br /> ,o , NON ,uN, mom <br /> TOWNSHIP RMITS MAY BE REQUIRED o 8 0 0 o S o o m <br />