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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator w _0 0 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for thi work y <br /> described and located as shown herein. The undersigned agrees that all work shall be done inccor- 3 C1 <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with al other 2 o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y m <br /> o <br /> OWNEREh PRD ) fQ TELEPHONE I-P— <br /> 'JJ <br /> PRD <br /> / V m <br /> HOME ADDRESS <br /> 178 7Q <br /> EMERGENCY/FIRE NUMBER l eROAD NAME ,[)ee(- pajj)-7i�)l Ili(, <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ! GARAGE/ACCESSORY STRUCTURE ADDITION a <br /> = r <br /> N --C <br /> 0 O l <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o v <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <br /> r <br /> o_ <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE C R <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. "n <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> 'n a co <br /> T o a <br /> 1. All required dimensions or distances to be shown or drawn to scale. n <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB) and indicate m N' <br /> North (N). m I = <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s) to centering of <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, (0 <br /> roads, lake, lot lines. 1 <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 mus be <br /> signed and dated by the owner. m <br /> g <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> _ <br /> CONDITIONS OF PERMIT: R <br /> N <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 <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> 6. `J Jd111 a( C• " ' � ��� <br /> :5UOCL, Ll- (n_C_ <br /> 7. _ ELr R <br /> 0 <br /> = F = <br /> 8. oT y ' : m <br /> f �cE m <br /> O <br /> R m m C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myrn <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and aCCL racy of : N w N p <br /> all information contained in this application(Including any accompanying schedule)and I further declare that 1 re ognize . o o <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- C : 0 <br /> c, O : <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Information I <br /> providing in this application. I agree to permit county officials charged with administering county ordinances c r other 3 ig <br /> authorized person to have access to the above described remises at any reasonable time for the purpose of insp ction. <br /> ♦ N <br /> SIGN HERE <br /> N ; <br /> (signatur owner or building contra r) ate) o <br /> (a <br /> ZONING ADMINISTRATOR � <br /> �Fn e>0 En Fn <br /> TOWNSHIP PERMITS MAY BE REQUIRED MMN N N N <br /> O N N O N " O 12 <br /> 000000 <br />