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Burnett County 7410 Co.Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ,c ' 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3, <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the ork T <br /> described and located as shown herein. The undersigned agrees that all work shall be done in a cor- m W <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all ther o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. _ <br /> E <br /> OWNER SigmFs HoFF TELEPHONE /ty IZ,5Z;6rp . Qi1Dg v <br /> 1 i m <br /> HOME ADDRESS5g1s -PUAY-IRk LA. A. P!yM�,.Mr!- 554 I � <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) - n <br /> IM, <br /> s o <br /> CONTRACTOR p <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION i <br /> y O <br /> O .. <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION <br /> 0 0° <br /> m <br /> t <br /> STRUCTURE/ADDITION USE: 9J <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE O s <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) p 3 N <br /> Z c <br /> 1. All required dimensions or distances to be shown or drawn to scale. i m P a <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB) and indicate C T. <br /> North (N). LQI <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 riv r. <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildin <br /> roads, lake, lot lines. + n <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. CJ N <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans mustibe t N x <br /> signed and dated by the owner. v <br /> i4 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION Bit- W <br /> FORE A PERMIT CAN BE ISSUED. <br /> 6' OJ M <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELIN . <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 9 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF HE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> 6. <br /> 7. y o c m a <br /> Q 2 n „ m <br /> FD' 12 <br /> E ? � <br /> 'R mi <br /> t Z F _! Cn <br /> 8. ? ?n: — MN : G)c [ D <br /> i o y <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the bee of my v <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and ace u acy of O <br /> oo o : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I re gnize <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining wheth r 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 infonnati n I am O v <br /> providing in this application. I agree to permit county officials charged with administering county ordinances other 3 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of insp ctlon. <br /> N <br /> SIGN HERE ^' <br /> ate) <br /> ZONING ADMINISTRATOR I I�: ��,���;, T <br /> I N N N N N N <br /> O WON , <br /> HIM <br /> Om <br /> TO NSHIP PERMITS MAY BE REQUIRED ! o 0 0 0 0 o m <br /> .� 000000N <br />