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ON COMPUTE CANNEQ - <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator w - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work � <br /> described and located as shown herein. The undersigned agrees that all work shall be done in accor. m w <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. N m <br /> o <br /> OWNERR p r L1° TELEPHONE o <br /> C, ll�i <br /> HOME ADDRESS <br /> k Wnbs _-e/ O 1 <br /> 1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CONTRACTOR I \ 1 <br /> 4 t— <br /> a <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION 0 <br /> H � o <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNryNII,T SUBDIVISION o C <br /> STRUCTURE/ADDITION USE: osm e <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) t <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE CR i <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. "n <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) X <br /> O 3 <br /> T v c <br /> 1. All required dimensions or distances to be shown or drawn to scale. 0 o ff <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB)and indicate m 9 q� 41y: <br /> North (N). w 1 <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) building(s)to centerlin of m <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. 5 w 3 a <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildi gs, R) R <br /> roads, lake, lot lines. G <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. O O — <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. a Cn <br /> Oj <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION B - Q <br /> FORE A PERMIT CAN BE ISSUED. o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. r <br /> CONDITIONS OF PERMIT: o <br /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. G <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. f <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 /> 0 a M <br /> 7. o c =0 9 <br /> g � 2. n � 3m <br /> 8. <br /> o : aS� C <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m . ' . m m <br /> PP ( 9 Y ) Y Y ' <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> 9 P 9 P Y <br /> all information contained in this application(Including any accompanying schedule)and I further declare that I recognize o m 0 <br /> that this Information I am providing will be relied 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 O p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances oi other 3 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of insp action. m v m <br /> al N <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) p <br /> ZONING ADMINISTRATOR , <br /> o : <br /> M <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N U N N N U <br /> outs o <n v, ono <br /> 000000 bo <br /> 00000000N <br />