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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator d - 0 0 <br /> APPLICATION FOR LAND USE PERMITS � 3 <br /> s <br /> TO THE ZONING ADMINISTfiwTUR: rhe undersigned hereby makes applicatitln for a Permit for the work � H <br /> described and located as shown herein. The undersigned agrees that all w rk shall be done in actor- m <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanity ion Code,and with all other 2. <br /> applicable County Ordinances and the laws and regulations of the State of W sconsin. �° <br /> OWNER—' <br /> TELEPHONE /J <br /> HOME ADDRESS 21 ( VfLe /J S(/ <br /> EMERGENCY/FIRE NUMBER UY ���ROAD NAME <br /> J c !� 1 tQ, 1 <br /> LEGAL DESCRIPTION(see tax receipt)S / T3 0�k j(,lr.w' 2-38-/ - O'?- Cb k&L <br /> CONTRACTOR <br /> am <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE DDITION <br /> T N ^ <br /> O <br /> SANITARY PRIVYFILLINGIGRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: �r0��1 4 , ' <br /> (Hom /Cab' ; Commercial B iness; Bedroom;Deck;at:.) <br /> r <br /> o_ <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. j kNY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. r <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 <br /> T a (n <br /> 1. All required dimensions or distances to be shown or drawn to scale. p <br /> P i <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB)and indicate nl 0 S.v <br /> North (N). y C� ° <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. a <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 a <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 /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. i <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 30 DAYS OF PERMIT I� <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLES 3 SPECIFICALLY a <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE I <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTE . <br /> 5. <br /> f <br /> 6. <br /> Nfn -vco > <br /> y q, c =.9 � � Fm <br /> 7. a � m9 <br /> 8. o co <br /> In <br /> I declare that this application (including an accompanyingschedule has been examin m m <br /> pp ( g y ) by ms and to the beat of my � �E , m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsib for the detail and accuracy of ': ��, 8t? p <br /> all information contained In this application(including any accompanying schedule)and I further declare that I recognize o m o , <br /> that this Information I am providing will be relied upon by the County of Burnett Wlscons n In determining whether to is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett lying on this Information I am p <br /> providing In this application. I agree to permit county officials charged with administer ng county ordinances or other 3; ig <br /> authorized person have access to the above described premises at any reasonable tim for the purpose of ins{octlon. <br /> SIGN HERE <br /> N ; <br /> (e re of wner building ontractor) I (date) <br /> ZONING ADMINISTRATOR Z d <br /> ;yy E E <br /> L <br /> �+NN0 ""om <br /> TOWNSHIP PERMITS MAY BE REQUIRED `^ o u v o v v, u' o m <br /> 8SS00006M <br />