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I l <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator do <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work H <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- ID <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other o O <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y m p <br /> /� m, <br /> OWNER ���-� t / / r Il TELEPHONE Q /_/a� o C <br /> HOMEADDRESS l6 J C /Ct <br /> �. � c) RS <br /> EMERGENCY/FIRE NUMBER �j ROAD NAME e6 n <br /> � <br /> LEGAL DESCRIPTION(seetaxreceipt) n4 �� 1 <br /> CONTRACTOR o <br /> 111 11 M <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION �- <br /> o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION v / <br /> CD <br /> STRUCTURE/ADDITION USE: l hw, <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> 4 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In <br /> 5' <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) A CO 3 <br /> "n ? rn <br /> ' o <br /> 5 <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). y <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of m �,� <br /> zs <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, U3 v <br /> roads, lake, lot lines. U <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. V <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be C r <br /> signed and dated by the owner. © cn <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE APERMIT CAN BE ISSUED. p <br /> s. J <br /> 2. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: v. <br /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT a� <br /> ISSUANCE. J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ? <br /> PERMITTED. v <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 /> rn rn -0Cn r> > <br /> 7. <br /> M o.v � w> > 8 $ m <br /> ? � ' <br /> oo <br /> M,o <br /> a T�: <br /> 8. o c m <br /> C <br /> m m i <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my m <br /> CD <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 any accompanying schedule)and 1 further declare that I recognize o o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 0 : 0 <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 p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or otheriQ <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T 3 w <br /> SIGN HERE <br /> ( natu of owner or ui ng contractor) (date) o <br /> ZONING ADMINISTRATOR <br /> �NNfn N N m <br /> TOWNSHIP PERMITS MAY BE REQUIREDo mo mo 0 0 ' o m <br /> 00000 0 0 <br />