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"czr- / <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR LAND USE PERMITS w <br /> z <br /> 70 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- `= ` <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other 3. <br /> o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y °' <br /> OWNER (�5 ,/./, }����,„ l� TELEPHONE <br /> HOME ADDRESS <br /> l�f S�tG, s1�/y 00 � <br /> EMERGENCY/FIRE NUMBER 'l-� �5 ROAD NAME <br /> d 4 <br /> LEGAL DESCRIPTION(seetax receipt) 6a4m1 <br /> 5 <br /> 15o% OF Loj S[-C 51- <br /> 31 zoT 6 �,:A Ll <br /> � y <br /> CONTRACTOR lb <br /> i4 0 <br /> TYPE OF PERM IT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> y r <br /> 0 <br /> 0 <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o � <br /> pp <br /> STRUCTUREIADDITION USE: P�AGIi ADD I rloly TU EX/STIA4�- C419/P <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> r- <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> a <br /> Z g� <br /> 1. All required dimensions or distances to be shown or drawn to scale. n 9 <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB)and indicate m y' <br /> North (N). w <br /> 3. 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. �_ a <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. LF <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. m <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. <br /> N <br /> 0. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> _( <br /> ISSUANCE. o <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. 9 <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. 0amw $ Em <br /> x `" 70 <br /> ones <br /> Z £ �I y; M <br /> 8. o = m <br /> i <br /> 0:? �c 0 0ai C <br /> o <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my w: ; M m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of , E V 5 2R: b <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize <br /> PP ( 9 Y 1 9 m o , <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 O p <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. <br /> N <br /> SIGN HERE <br /> i i i N i i <br /> I gnat reof own or uilding contractor) <br /> a of <br /> ZONING ADMINISTRATOR AIN i E E <br /> TOWNSHIP PERMITS MAY BE REQUIRED 4a 0 0 0 o g o o y <br /> 0000 <br />