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01 cam, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator rn v -i Z <br /> APPLICATION FOR LAND USE PERMITS F °_ <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work <br /> ar <br /> described and located as shown herein. The undersigned agrees that all work shall be done in Accor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with alb other 3 8 <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. ° (0 <br /> OWNER �//,,pp 'j/' TELEPl.�1 [� /�Q/C�q- a3(-B3 i v <br /> O <br /> F16Em <br /> /� / m <br /> HOME ADDRESS 3 <br /> EMERGENCY/FIRE NUMBER -1 T-13'?J ✓r 0c. t4e I <br /> ROAD NAME �t y L� <br /> LEGAL DESCRIPTION(see tax receipt) 1' G f- C� <br /> / <br /> CONTRACTOR f? <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION < <br /> � o <br /> o' <br /> H O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT T_SUBDIVISION Z <br /> c , <br /> p <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) T <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE Ort <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> -n {yJ <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) A <br /> O <br /> 1. All required dimensions or distances to be shown or drawn to scale. T o g <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings (NB)and indicate c 9 <br /> North (N). a <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s) to centerlinelof m °C <br /> road, (c) building(s) measurement to the ordinary high water mark(OH WM) of lake, stream or rivet. r <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildings, O <br /> roads, lake, lot lines. <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. vl <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be <br /> signed and dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE. v <br /> FORE A PERMIT CAN BE ISSUED. <br /> o IO n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. '- Y <br /> CONDITIONS OF PERMIT: <br /> 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT . W <br /> ISSUANCE. I� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE, /v <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ( Z <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. <br /> s. '7�Ee <br /> 6. <br /> 7. m F 09-M � <br /> 8. v 'o ? Cz m3 <br /> P f� ' y <br /> ;! l <br /> Gi 2�9 m <br /> o f E w c i i C <br /> �: a <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my <br /> . m : m70 <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of ,�, y- , m <br /> all Information contained In this application(including any accompanying schedule)and I further declare that 1 reeogryize <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether tO Is- E 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 am, ' <br /> providing In this application. I agree to permitcounty officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. T E <br /> a m <br /> SIGN HERE f^ f t Ci oc- X � 96 H <br /> N <br /> owner or b Itling contactor) (data) o <br /> ZONING ADMINISTRATOR O o <br /> 1)ITt?wwm -n <br /> TOWNSHIP PERMITS MAY BE REQUIRED \1 o Np o ^n N pp" ' m <br /> I O O O O O O O O M <br />