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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator o 0 <br /> .APPLICATION FOR LAND USE PERMITS o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work y r� <br /> described and located as shown herein. The undersigned agrees that all work shall be done in aeeor- fD W <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. <br /> OWNER <br /> /1�/L) E�, C. /_s a^3 TELEPHONE <br /> HOME ADDRESS <br /> H � <br /> EMERGENCY/FIRE NUMBER �/� ROAD NAME .S-" PIN <br /> C' vl <br /> P <br /> LEGAL DESCRIPTION(see tax receipt) nor N . ,� 3 Rib/ �� 7��hy /VI¢r�:j y�✓ t���y. <br /> CONTRACTOR p fl ' <br /> 4 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION 0 rJ' <br /> N Or <br /> O <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION -. <br /> o <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Com rcial Business; Be room;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. O 1 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) p <br /> T ? m <br /> T o <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 <br /> North (N). (a = <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. 1 <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. VJ in <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. w <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. I Co <br /> 4 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- 117 = <br /> FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 <br /> e G <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT l>J <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 ;it <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 /> 6. <br /> J� �2 gym <br /> r/� Y <br /> �. n . <br /> 7. Q � � m��� s' cym m o S � <br /> =`a SE <br /> Z f = : '-I Cn : ZI <br /> C <br /> f " a C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my g ` y i m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ,,, m E t3 <br /> all information contained In this application(including any accompanying schedule)and I further declare that I recognize o o <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether 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 information I am <br /> 0:: v <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 ': <br /> authorized person to have access to the above described promises at any reasonable time for the purpose of Inspection. <br /> SIGN HERE <br /> (signature of owner or building contractor) <br /> ZONING ADMINISTRATOR <br /> ARZ290 <br /> I� /� <br /> �NNNfJNN(l <br /> TOWNSHIP PERMITS MAY BE REQUIREQ 4 Y p n n o m n n o m <br /> 88S8o800V <br /> 1i � <br />