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on ! <br /> Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator En ; o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work H <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- / 1wI1 ,, <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. H w <br /> OWNER TELEPHONE m <br /> L✓Lc l/.�t A x his-asr - 3390 <br /> HOME ADDRESS <br /> 33oov f v 35- Dan bC(rT <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) C' / SZ// yVVV77T7���71on/ TQC ('(� <br /> CONTRACTOR �C/l ✓ /OWN O /.SUJ%ST <br /> `T o <br /> g S <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE- ADDITION S <br /> � r <br /> N O <br /> O » <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> 0 0 <br /> STRUCTURE/ADDITION USE: p�.o L �u3/NESS" 1 /;A11. S' -Ora'-1g 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. T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> -n 'P m <br /> TZ <br /> 1. All required dimensions or distances to be shown or drawn to scale. n P FL <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB) and indicate m y' <br /> 9. <br /> North to <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. <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildings, O �� <br /> roads, lake, lot lines. UP <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 /> signed and dated by the owner. v <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. m <br /> CONDITIONS OF PERMIT: o <br /> H <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 Z <br /> PERMITTED. 11) D <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE v <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. U 11 <br /> 5. <br /> 6. �5 P_ <br /> y Q, c �. � �� � fm <br /> 7. m $4 - am c: m <br /> C O O m 3 <br /> 8. o —(N: IM <br /> � -» <br /> G� 2 m <br /> Ri <br /> a c C <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m ` i 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 /> all Information contained in this application(including any accompanying schedule)and 1 further declare that I recognize <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- E o o <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 n p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person 101"ya access to the above described premises at any reasonable time for the purpose of Inspection. m : v m E <br /> m <br /> q i i i '• <br /> SIGN HERE <br /> ( gn ure of) r or bul ing conVactor) =(dab) o <br /> ZONING ADM TRATORwt2 -n <br /> ' <br /> i o m ,�Ni+ o � NUNiom <br /> TOWNSHIP PERMITS MAY BE REQUIRED 1�`-_ h� 0 0 o 0 g ' o y <br /> 0000 <br />