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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Adminis ratord 0 0 <br /> APPLICATION FOR LAND USE PERMITS2. <br /> z s <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 inaccor- <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. y m <br /> O <br /> OWNEROk441-" ` TELEPHONE 15, 3 0 <br /> C-c a <br /> HOME ADDRESS / & <br /> EMERGENCY/FIRE NUMBER JC'Q 7 t / 2 ROAD NAME /+' „ <br /> LEGAL DESCRIPTION(see tax receipt) s aO / <br /> CONTRACTOR K <br /> V m 0 C <br /> 2 0 1 <br /> TYPE OF PERMITK. DWELLING/BUILDING- GARAGE/ACCESSORY STRUCTURE ADDITION � =- <br /> o <br /> o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT ScUB�DIVISION <br /> C/ / / x egj rtil a <br /> ° <br /> STRUCTURE/ADDITION USE: W � D 7 Q <br /> (Home/Cabin;Comr4cial Business; Bedroom;Deck; etc.) <br /> r <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE C R <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O a <br /> -n P ti <br /> T o a <br /> 1. All required dimensions or distances to be shown or drawn to scale. � <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB)and indicate m N: <br /> North (N). y <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. s <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildings, Cid <br /> roads, lake, lot lines. N <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 c e <br /> signed and dated by the owner. .Cn <br /> 2 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION B - a <br /> FORE A PERMIT CAN BE ISSUED. Q <br /> o r� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z C <br /> CONDITIONS OF PERMIT- <br /> 1. <br /> ERMIT:1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMI <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 T <br /> PERMITTED. 9 <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 /> oin =0 2a* m <br /> a4 R ho » M <br /> 7. Is m 3 : °i cu o' S3 <br /> V < W : `� N O O a <br /> N O Z : : <br /> ZJ �I y <br /> 8. o = <br /> ' � m <br /> m m rn <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the bes of my m <br /> knowledge and belief it Is true, correct and complete. I acknowledge that I am responsible for the detail and accu racy of O <br /> all information contained in this application(including any accompanying schedule)and I further declare that I rei ognize <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining wheth r to Is- o . o <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 Infonrl on I am O p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances c r other 3 i4 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of insp iction. m m <br /> m : <br /> SIGN HERE 'S <br /> (slat a of owner b ding contractor) (date) o op E <br /> ZONING ADMINISTRATOR � '• <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N N N N V <br /> O t n N O t n N O <br /> 0 0 0 0 0 0 O <br />