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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Adminiskrator d/ l l-0 0 0 <br /> APPLICATION FOR LAND USE PERMITS w 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 inccor- `= ` <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with al I <br /> other 5 <br /> 0 <br /> applicable County Ordinances andthe aws and regulations of the State of Wisconsin. 0 <br /> n <br /> OWNER501Mri p TELEPHONE <br /> lephmo <br /> O r m <br /> m <br /> HOME ADDRESS C1 � <br /> EMERGENCY/FIRE NUMBER ROAD NAME ' / —� \ <br /> LEGAL DESCRIPTION(see tax receipt) I 6E <br /> C I-7_ -L:7 <br /> t� I <br /> CONTRACTOR -1�ra — r / o <br /> lJ O <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION <br /> <- <br /> m <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 79 <br /> 1 o ao <br /> `/ <br /> STRUCTURE/ADDITION USE: c6 I /� P <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. In <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) p 3 <br /> -n 'R N <br /> TZ 0 <br /> 1 .All required dimensions or distances to be shown or drawn to scale. n p <br /> 2. Show the location and size of all existing buildings(EB) and all new buildings (NB) and indicate m y <br /> North (N). 0 <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerlir e 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 /> 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 MUE t be <br /> signed and dated by the owner. u <br /> I � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION E- ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 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 SHORELI 4E. <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. p <br /> >) o c d a F rmrt <br /> 7. M <br /> e <br /> P m <br /> CE <br /> < N 'z H O <br /> 9» N O : N Z : —1 <br /> M <br /> i i G>2 i i m <br /> D <br /> o : ate : C <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the bet of m ` L7 <br /> PP C 9 Y ) Y Y y m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and acc iracy of <br /> all information contained in this application(including anyaccompanying schedule)and I further her declare that Ieognize _ . <br /> O <br /> 0 1p o <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whett or to is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this informal on I am i n o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances Dr other 3 8 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of insl lection. m m <br /> ID N <br /> SIGN HERE H �N <br /> o : <br /> (signature of owner or building contractor) (date) i o <br /> ZONING ADMINISTRATOR <br /> o : <br /> N N N N N NN m <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 000 0 0 0p <br /> m <br /> 0 0000000 fA <br />