1996/12/02 - SANITARY - SAN - Other (2)

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Burnett County 7`410 Co. Rd. K, No. 102, Siren,WI 54872 Offi5atf Zoning Administrator d M o o APPLICATION FOR LAND USE PERMITS 5 3 TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work � N described and located as shown herein. The undersigned agrees that all work shall be done in accor- dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other 3 '� 0 applicable County Ordinances and the laws and regulations of the State of Wisconsin oteo:, H z7ss-3t.- m OWNER _ 003-A 1 'Jy\' Fig 1�n t�� TELEPHONE 7�r- 3 lJ It w m i HOME ADDRESS —7 Z LD gya l f r' 1 EMERGENCY/FIRE NUMBER ROAD NAME 4Lr-s- 13 — f/a 'ISS S36/ Rt7fhglyw 2 _ 3$—/N- 6S'_ O 01.300 LEGAL DESCRIPTION(see tax receipt)/ N 1 9L Y fro 4- 12 $t K .2 C r fry_S 9 CONTRACTOR Off_ \ 6!J(ZI o �w � TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION 0 <» — m SANITARY RIVY ILLING/GRADING CAMPING UNIT SUBDIVISION Z 0 CD STRUCTURE/ADDITION E: )iV (Home/Cabin;Commerci I Business; Bedroom; Deck;etc.) 0 A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. c O DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O O g -n C 1. All required dimensions or distances to be shown or drawn to scale. n $ 0 2. Show the location and size of all existing buildings (EB)and all new buildings(NB) and indicate m y: North (N). w �>Q 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of m t road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. Q :� 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildings, roads, lake, lot lines. 5. Indicate if a walkout basement is planned and show areas to be graded or filled. O 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be 4— signed signed and dated by the owner. c NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° FORE A PERMIT CAN BE ISSUED. o THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. CONDITIONS OF PERMIT: N v, 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. �U 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Z PERMITTED. 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. 5. 6. o c-0m cDi D � 7. M, OmCL < N 'z N O t0 � (D O N oc2m G) D 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my w m knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of p all information contained in this application(Including any iaccompanying schedule)and I further declare that 1 recognize E o m o that this Information I am providing will be relied upon bye County of Burnett Wisconsin in determining whether to is- b , b o : o : sue a permit. I further accept all liability which may be a reisult of the County of Burnett relying on this Information I am ; o: p providing in this application. I agree to permit county offigials charged with administering county ordinances or other authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. n m SIGN HERE Z H N (signature of owner or building contractor) (date) o ZONING ADMINISTRATOR �J 1lYl IG�(11 C o ' wt»t»fft61) tat»tn— 't TOWNSHIP PERMITS MAY BE REQUIRED o 6 0 0 N 9 0 o m oSooSSSSfn