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OY) ay-yz p <br /> Burnett Ctanty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator d - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work " o _1Z) <br /> c <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- 3 � <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 th St to of Wisconsin. y u <br /> OWNER TELEPHONE o <br /> HOME ADDRESS ` • C <br /> A/- ` <` ^ �n `, r .�� <br /> / V' <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) Ltd �hJ [Drlde r I+re,, <br /> CONTRACTOR <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING �/ GARAGE/ACCESSORY STRUCTURE ADDITION 0 »- <br /> m <br /> 0 <br /> SANITARY PRIVYFI LING/GRADING CAMPING UNIT SUBDI ISION <br /> STRUCTURE/ADDITION USE: uJ'rjt/Id•IV N n `1 <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. n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) z o <br /> O 3 <br /> T a N <br /> 1. All required dimensions or distances to be shown or drawn to scale. o a <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings (NB)and indicate m <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. L� <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 must be ry n.- <br /> signed and dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. <br /> N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. '- <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT a <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE ZZ <br /> 5. OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 6. <br /> 7. s vmR f <br /> m m < SCg .m <br /> < <br /> s : 2 AN p <br /> 8. C F J T N <br /> D 2 <br /> o : we <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of i3 N <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize i io o <br /> that this information I am providing will be rolled upon by the County of Burnett Wisconsin in determining whether to is- <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 ? p <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 premises at any reasonable time for the purpose of inspection. m ? m <br /> m <br /> N <br /> SIGN HERE <br /> (signature of owner or building contractor) <br /> ZONING ADMINISTRATORI/rC�i <br /> I 3-►995 <br /> TOWNSHIP PERMITS MAY BE REQUIRED I <br /> O <br /> j (nNOrnN O <br /> 0 0 0 0 0 0 0 0 <br /> t.__...._... OOOOOOOO <br /> I <br />