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OVI C'ey, ' <br /> Burnett Coun* 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 3 3 -01 o <br /> APPLICATION FOR LAND USE PERMITS d o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work v c <br /> described and located as shown hereother in. 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 om <br /> m <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. c <br /> OWNER 1 / IV) 11—et rte/ TEL�EPH(ON�^(A�_ <br /> HOME ADDRESS /� �j Q f (m,z_ C n s)e <br /> EMERGENCY/FIRE NUMBER :;L 7 S 3 O ROAD NAME <br /> � <br /> �. <br /> LEGAL DESCRIPTION(see tax receipt)Nie- NeS 34 o' <br /> -p <br /> CONTRACTOR O <br /> °< <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION H <br /> 0 <br /> v <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> STRUCTURE/ADDITION USE: U1. <br /> (Hom �Cabi Commercial Business; Bedroom;Deck;etc.) � . ^ <br /> �) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m �q <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> A � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) T y <br /> 'na <br /> n o FL <br /> 1. All required dimensions or distances to be shown or drawn to scale. m y. <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB)and indicate 0 <br /> M I <br /> North (N). to <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of <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, <br /> roads, lake, lot lines. (� <br /> reas to be graded or filled. <br /> 5. Indicate if a walkout basement is planned and show a 1 <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must beCn <br /> \ <br /> signed and dated by the owner. 1 o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. <br /> 2. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT _73 I0 <br /> ISSUANCE. 0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. (� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY - 19 <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. o c N; D D f m <br /> M - a� P'- am <br /> 7. <br /> G M <br /> ': ` (j 2 m <br /> 8. o : , E E C <br /> o <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my y G <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of o o <br /> all information contained in this application(Including any accompanying schedule)and I further declare that I recognize C��; 0 m 0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Is- <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 ' F' <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 1 m : <br /> A <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> N 63: <br /> SIGN HERE na) <br /> (signature of owner or II g r) <br /> o <br /> ZONING ADMINISTRATOR �»Fn w�'e3 Fn n m <br /> N N N N N N T m <br /> N N O (n f T O N O m <br /> TOWN HIP PERMITS MAY BE REQUIRED o 0 0 0 0 0 0$ N <br />