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altompI <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator (n -0o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. _ <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work N <br /> described and located as shown herein. The undersigned agrees that all work shall be done in ccor- 3 <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with al I other - o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> F <br /> OWNERti �� TELEPHONE <br /> m <br /> m <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER 03 ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) ,c-�t NE t = v ` K,) <br /> CONTRACTORO <br /> ✓/ S <br /> 'm O <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION 0 i <br /> N � <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> Z ° <br /> v <br /> m <br /> STRUCTURE/ADDITION USE: 17/ <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. In <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> -n P m <br /> n Z C <br /> 1. All required dimensions or distances to be shown or drawn to scale. 5 P <br /> 2. Show the location and size of all existing buildings(EB) and all new buildings(NB) and indicate In 5.o <br /> North (N). C <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of In <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 /> 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 mus be <br /> signed and dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION E- 7j ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> vi <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ? <br /> PERMITTED. i 0 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF HE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> F <br /> 6. <br /> m(nvmrDD � <br /> oc =. wdnn <br /> 7. mE M <br /> o 5' 3< N 2 N O = m <br /> z f 0 ' T� <br /> 8. o _sn m <br /> in <br /> o m m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the bestof my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and aCCL racy of /`' <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize (A ` 00 0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whethi ir 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 p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances c r other 3 2 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of insp action. <br /> SIGN HERE <br /> N <br /> gnature of owner or building contractor) (date) o [ <br /> O <br /> ZONING ADMINISTRATOR LAY) _ <br /> • to EntnT <br /> - N N N N N N N m <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 0 0 o m <br /> 00000000U) <br />