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At County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Adminis rator ,� o <br /> APPLICATION FOR LAND USE PERMITS w 3. <br /> e <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 inaccor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with alI other o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> SL 0 <br /> OWNER r TELEPHONE-- �� y 3__33 <br /> I <br /> HOME ADDRESS -2t� e� _ —� In <br /> EMERGENCY/FIRE NUMBER ROAD NAME �. 1 <br /> LEGAL DESCRIPTION(see tax receipt) 1 <br /> 37 � <br /> CONTRACTOR / <br /> ,f g <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE—ADDITION-eft" 0 <br /> N <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o ° <br /> m <br /> STRUCTURE/ADDITION USE: <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. <br /> X S) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> 7i a rn <br /> Z a <br /> 1. All required dimensions or distances to be shown or drawn to scale. n P o <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB) and indicate m / y: <br /> North (N). m <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. U <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. 1 <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. 0 <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be x <br /> signed and dated by the owner. R <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATIONBE- <br /> FORE A PERMIT CAN BE ISSUED. 2. <br /> v <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: _ <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 SHORELI 14E. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. �J <br /> 5. <br /> f <br /> 6. <br /> a rnrnv � 6, , <br /> oc �. <br /> 8 $ <br /> a� am a, m <br /> 7. Ay. <br /> 8. u € 2 m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the be at of my m m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and aci uracy of <br /> 00 0 : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I r Pcognize o m o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whet ier to Is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this informs Ion I am O i p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 i4 <br /> authorized person to have access to the above described premises at any reasonable time for the,purpose of lona <br /> � u <br /> SIGN HERE <br /> (a re o nor r building contractor) <br /> (date) <br /> ZONING ADMINISTRATOR OCT I T 199 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o v o 0 0 0 0 0rn <br /> --- -.- o $ o 00000t(h <br />