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01011"I dornp r <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator d 0 0 <br /> APPLICATION FOR LAND USE PERMITS z 3' <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work N <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Codetand with a II other 3. o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y w <br /> _ c v <br /> OWNER — TELEPHONE` m r <br /> I <br /> HOME ADDRESS M <br /> I <br /> EMERGENCY/FIRE NUMBERj ROAD NAME ,jO ) f P <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CONTRACTOR <br /> � o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> � r <br /> N � <br /> O <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION v <br /> Z O <br /> STRUCTURE/ADDITION USE: C] X <br /> 4p �SN4 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> r <br /> O <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 /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 <br /> 'n P rn <br /> pz <br /> 'nZ S <br /> 1. All required dimensions or distances to be shown or drawn to scale. m <. <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB)and indicatey. <br /> North (N). <br /> N. <br /> 3 <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s) to centerl ne of m <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM) of lake, stream or I iver. UI <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildings, <br /> uil ings, <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 ITI.st be <br /> signed and dated by the owner. CA <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. ��1.1 <br /> 0 ' 1 ' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. W <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERN IT <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 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 /> mv,vmr > > 0 <br /> m <br /> 7. a FII -Ram MIX <br /> Z £ <br /> 3i TN: M <br /> G C <br /> 8. <br /> M <br /> o nom ; C <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the b st of m ` ` M <br /> PP 1 g Y ) Y Y ! cl <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and a uracy of E `('„ y w O <br /> o <br /> all information contained in this application(Including any accompanying schedule)and I further declare that I cognize oo :c m o , <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whe her to Is- o o <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Inform tion I a o <br /> providing in this application. I agree to permit county officials charged with administering county ordinancei or other ' <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of In ipection. <br /> N <br /> SIGN HERE <br /> (sl na of owner or building contractor) (date) g i <br /> I <br /> ZONING ADMINISTRATOR <br /> N N N N N N w m <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 o u, o 0 0 <br /> p m <br /> 8 0 0 0 0 0 6 0 M <br />