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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work N g <br /> described and located as shown herein. The undersigned agrees that all work shall be done in ccor- 3 0. <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with al other - o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> g (� <br /> /�J C o mo <br /> OWNER H <br /> w C7 C <br /> ( <br /> HOME ADDRESS I) 1 L U r <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) K� <br /> CONTR CT rR <br /> 0 <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTUREADDITION iS � <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION v n <br /> P o l` I <br /> m <br /> STRUCTURE/ADDITION USE: ' <br /> ( e/Cabin, ommercial 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. m <br /> X o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> O B <br /> -n P rn <br /> T o a <br /> 1. All required dimensions or distances to be shown or drawn to scale. n <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB)and indicate m 91 5. <br /> North (N). C o"� ° <br /> 3. Show dimensions in feet of the following: a building(s)s to all lot lines, b building(s)s to centerlin of m <br /> O ngO O 9O <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or riv r. <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildi gS, <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 <br /> signed and dated by the owner. 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- °_ <br /> FORE A PERMIT CAN BE ISSUED. o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT a I <br /> ISSUANCE. -(— <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. d <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY D <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 /> mwvn� $nov <br /> 7. m 0' � P'. 'n0a <br /> m <br /> a � — <br /> 8. 0 <br /> oci <br /> c <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m � '• �-��-, <br /> PP f 9 Y ) Y Y ?fid <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whetherto is- m <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this InformationI am p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances oi other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. <br /> SIGN HERE /0//7A26fA� <br /> (sl at a of owneo <br /> r or I ng contractor) (date o <br /> : <br /> ZONING ADMINISTRATOR <br /> »fJNtn NN Mm m <br /> u, <br /> TOWNSHIP PERMITS MAY BE REQUIRED N o u, `" " o m <br /> 000000bo <br /> 00000000N <br />