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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 0 ✓o <br /> APPLICATION FOR LAND USE PERMITS o <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- 3 g <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. 7 <br /> / �/ 02- - 6 <br /> OWNER �n/� �/ �L/ r (� <br /> yI <br /> HOME ADDRESS 20 \4,1 Q <br /> EMERGENCY/FIRE NUMBER / d <br /> �7 C/7 ROAD NAME `�o <br /> ern ►s )v u/ _ <br /> LEGAL DESCRIPTION (see tax receipt) 16.T .Z CS /I V .-Z P 2 O 44, LO T l D � <br /> CONTRACTOR L o <br /> �/ O <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY GARAGE/ACCESSORY STRUCTURE ADDITIONY, Q g <br /> N <br /> O <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o $ <br /> m <br /> STRUCTUREIADDITION USE: <br /> (Home/Cabin;Com tial Business;Bedroom;Deck;etc.) <br /> r <br /> o_ <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> 1(3.. <br /> GIBLE PLOT PLANS WILL BE RETURNED. <br /> ECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) p 3 u <br /> T o <br /> All required dimensions or distances to be shown or drawn to scale. m <br /> Show the location and size of all existing buildings(EB) and all new buildings(NB)and indicate y. <br /> North (N). N (� <br /> Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of m I <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM) of lake, stream or river. x <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. I <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 /> 8 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- OJ <br /> FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. m <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT n I' <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. J V <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 1 n <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. <br /> 6. 81,519'6 <br /> � 4= =gjA m <br /> 7. Rs �n� � M <br /> 9 < N (0 O <br /> N O 1D 1 <br /> 8. <br /> P Fes ; i Tyi i <br /> G � 1 O <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ' m <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 an accompanyingschedule and 1 further declare that I recognize <br /> E o 0 <br /> PP ( 9 Y 1 9 o $ ; <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Is- E <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 ' <br /> providing In this application. I agree 4o permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. ppm ? y <br /> SIGN HERE <br /> (slgnatura or ftnor by(IEin e c i �asW <br /> ZONING ADMINISTRATOR 11 g , ' '• <br /> N N U7 N N N N m <br /> OWNSHIP PERMITS MAY BE REQUIRED ( N N O u N N O <br /> Llil l0 009oy <br /> 0 <br /> i <br /> __i <br />