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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for th work <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 withal other o <br /> applicable County OrdinancQs and the laws and regulations of the State of Wisconsin. Z <br /> OWNER I VJ (1 11(aln5 Pr / �So r-f TELEPHONE <br /> v <br /> �� ��; <br /> HOME ADDRESS buci k11- <br /> EMERGENCY/FIRE NUMBER u ff 11 ROAD NAME <br /> 1 u � <br /> LEGAL DESCRIPTION(see tax receipt) I , ��, J ����(•`, T37�U-'�? �'(_,J <br /> CONTRACTOR pgo <br /> 3� <br /> ( I <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE-)C--ADDITION 0 - ` <br /> y rc /v <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> I P � <br /> STRUCTURE/ADDITION USE: ec-L0w <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 L <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 <br /> T 'P rn <br /> T Z c <br /> 1. All required dimensions or distances to be shown or drawn to scale. m P <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB)and indicate H <br /> North (N). m C <br /> 3. Show dimensions in feet of the following: (a) buildings) to all lot lines, (b) building(s)to centerli of <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM) of lake, stream or ri er. (J} <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildi igs, <br /> �J <br /> roads, lake, lot lines. o <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 (J <br /> signed and dated by the owner. cn <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION E E- Q ° <br /> FORE A PERMIT CAN BE ISSUED. p <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <br /> W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMI <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 9 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF HE o� <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> 6. &( Iola mss 10v <br /> 7. 70 — S�2. 1 $ a m <br /> z <br /> n � K , mo ' 3 <br /> : <br /> 8. a F ' i 2� M <br /> Vj m <br /> RUB <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the bet of my m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and ace racy of <br /> o� o : <br /> all information contained In this application(including any accompanying schedule)and I further declare that 1 ognize <br /> Is- <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whet r to Is_ <br /> . <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this informat on I am n E o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances r of <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of ins etion. m <br /> d <br /> SIGN HERE �� <br /> (s�nat ra of own building contractor) atelra of own building contractor) ate) o <br /> of <br /> ZONING ADMINISTRATOR : (q <br /> G N N N NN N m <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 `n ' 0 P m <br /> 00008 0o0 <br />