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v J <br /> Burnett Cownty 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator 0 o <br /> APPLICATION FOR LAND USE PERMITS o —a <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 actor- 0 <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other H <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> OWNERk P V t f V S (J!M TELEPHONE 6-3 ��5/� ! o 0 <br /> I� 1 �y{"/w73�"r / <br /> y <br /> HOME ADDRESS 1/ 7 SuJ • ', ryl 1 `I "f"G''P !'t�I L'.. <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> C // <br /> LEGAL DESCRIPTION(see tax receipt) .F Sc 'l� S-S K -r- 7 (c,L� <br /> CONTRACTOR L�-f- <br /> TYPE OF PERMIT(S):DWELLING/BUILDING- C��// <br /> —GARAGE/ACCESSORY STRUCTURE ADDITION u ^ <br /> o C <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o a \ <br /> m 1r\ <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) �• <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m I� <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O s: <br /> X 8 C` <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) OT B i <br /> n o n 1 <br /> 1. All required dimensions or distances to be shown or drawn to scale. W <br /> 2. Show the location and size of all existing buildings(EB)and all new buildings(NB) and indicate m N.C O <br /> North (N). m <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of p s <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. t <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 ?� <br /> m <br /> signed and dated by the owner. <br /> o. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- fl W <br /> FORE A PERMIT CAN BE ISSUED. ; - <br /> 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: �. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> 1 � <br /> ISSUANCE. � ' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Z <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. f <br /> 6. a s= =; � ' $ m <br /> G0 : T <br /> cit : : m <br /> 8' 0i LEI C <br /> 0 <br /> o 1 m m : <br /> i <br /> W : <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my OI . . y ! G <br /> om o : <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ze u, m 0 , <br /> all Information contained in this application(including any accompanying schedule)and I further declare that 1 recognize o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- 0 , <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 i i m <br /> application. I agree to permit county officials charged with administering county ordinances or other <br /> providing In this 9 P ` c <br /> m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. i a <br /> H fA: <br /> O <br /> SIGN HERE (date) ` i <br /> (algnatum of owner or ildl n <br /> ZONING ADMINISTRATOR Fn N N N N N N m <br /> Ctyu, Nov, u, u, om <br /> TOW HIP PERMITS MAY BE REQUIRED S 8 0 8 0 0 o S m <br />