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on Z'0?1L-P. <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WE 54872Office of Zoning Admini:1 trator o 0 <br /> APPLICATION FOR LAND USE PERMITS 1 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit forth work z <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- m <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with a I othera <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y w <br /> n� (L 22 ppp c `? <br /> OWNER/;(/ .1rY1 y, (� IYTM0.AMAJ�hYt TELEPHONE 3� g o <br /> HOME ADDRESS � q � �() M�r7 (� �9 l� ) .�XOn <br /> 'I l Yn ry W 5if3�a <br /> EMERGENCY/FIRE NUMBER AAjqSC, ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) <br /> S io.111I ' <br /> W13fIR4 Soy T38 RIS 5 O <br /> CONTRACTORs A4 9 _ 3$ _ , i ,D–O a O 10 <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE—y—ADDITION— RC1 <br /> m O <br /> SANITARY PRIW FILLING/GRADING CAMPING UNIT O SUBDIVISION ' � <br /> STRUCTURE/ADDITION USE: <br /> ( me/Cabin;Commerci I siness;Bedroom;Deck;etc.) <br /> r <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE CR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) I ;a 2 <br /> l r c m <br /> 1. All required dimensions or distances to be shown or drawn to scale. n o n <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB)and indicate m — N <br /> North (N). y <br /> 3. Show dimensions in feet of the following: a building(s) ( ) g( ) m <br /> ( ) ng(s)to all lot lines, b building(s)s to centerline of � <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM) of lake, stream or rivi r. r <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. C <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must�e <br /> signed and dated by the owner. I <br /> i ( N <br /> U g <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION B�- –' <br /> FORE A PERMIT CAN BE ISSUED. Q <br /> i 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW, <br /> CONDITIONS OF PERMIT: o <br /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W <br /> ISSUANCE. 00 <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. :b <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF T1iE <br /> 5 OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> I <br /> 6. <br /> I <br /> 7. x s m <br /> n ! K'� am = <br /> 4 m m <. : 'mCHo g <br /> 8. fes : TQi =1 <br /> p _ y : <br /> c: <br /> In <br /> i o E i <br /> RIC :IC i O <br /> me , <br /> I declare that this application,Including any accompanying schedule) has been examined or me and to the best f my ? ': m <br /> knowledge and belief It is true,correct and complete. 1 acknowledge that I am responsible for the detail and accura y of E ,�, iu N; m <br /> by <br /> all Information contained in this application(Including any accompanying schedule)and I further declare that I regio nize E o(o o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether o Is- i o m o <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying to this information I am <br /> Is- <br /> providing in this application. I agree to permit county officials charged with administering county ordinances Information <br /> they O $ <br /> m : <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of iespec Ion. 3 rn <br /> SIGN HERE �+ [ <br /> pl f owner or b I contractor) 7 3 ro <br /> (tlata) g <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> g0Sa 00gfmn <br />