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ink 4n�/ <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator w I 0 0 <br /> APPLICATION FOR LAND USE PERMITS3. <br /> v o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the workN <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 all other - o <br /> applicable County Ordinances and the laws and re ulla��tions of the State of Wisconsin. y <br /> o /2 �0/\ 'A <br /> OWNER TELEPHONE <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME Z MN -1551/0 <br /> cr t ; ry Y to <br /> LEGAic e— <br /> L DES1 .CRIPTION(see tax re pt)�®% -f 7 <br /> CONTRACTOR / <br /> 1.5-7 e _v, <br /> G <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> r <br /> N O <br /> O <br /> SANITARY PRIVY "DING-CAMPING UNIT SUBDIVISIONSTRUCTURE/ADDITION USE• Co 1 t?h S Cr rt\0_-VIe-d <br /> (Home/ in;Commercial Business; Bedroom;Deck;etc.) <br /> o_ <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> bi <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O S <br /> m 7 rn <br /> Z <br /> L1 <br /> 1. All required dimensions or distances to be shown or drawn to scale. n <• <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB)and indicate m y <br /> North (N). m i <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. UQ 3i <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. 0 C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> o <br /> vv v" <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. / rt <br /> CONDITIONS OF PERMIT: o V I <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. 71 Z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <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. <br /> 7. 2a 0 <br /> fm m <br /> oc �.m <br /> m CL Cin O <br /> v m' o ? CO2 <br /> Z F : Thi <br /> 8. ° �' c m <br /> 0 ; cry : D <br /> o;CCL <br /> C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ` '• <br /> 70 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of N m d'„ : O <br /> om <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize 0 m o0 <br /> that this Information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether.t6'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 Information I am n o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other : 3 : 8 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. T ; (D m <br /> SIGN HERE2 <br /> sign urs of nerppbuilding contractor) date) o <br /> ZONING ADMINISTRATOR $ <br /> F»wF»f'F»vifnr' �I <br /> � NNtli <br /> FO CM m <br /> Ln <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 000 0 0 0o� 0 6 o m <br /> 0000 $ 0000 <br />