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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m _MU o i o <br /> APPLICATION FOR LAND USE PERMITS 5; 3. <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- m3 � <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with al other o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. - m <br /> OWNERS) i�IV'UU ijt L qt- VOA),Ue TELEPHONq -,/r� <br /> �c m <br /> HOMEADDRESSAI T7 G0.eK \2d_ — <br /> , <br /> EMERGENCY/FIRE NUMBER Z/ �7 } ROAD NAME (e CIC <br /> LEGAL DESCRIPTION(see tax receipt) —A)E f 2_ — 1 <br /> CONTRACTOR <br /> � o <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE DDITION �- <br /> N Q <br /> O <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION— <br /> STRUCTURE/ADDITION USE: Aly Apfe I v ' <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 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 /> m P N <br /> 1. All required dimensions or distances to be shown or drawn to scale. o a <br /> 2. Show the location and size of all existing buildings(EB)and all new buildings (NB) and indicate m y: 7 <br /> North (N). y <br /> r <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerlin of m <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or riv Br. <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildii igs, SOI <br /> roads, lake, lot lines. <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. <br /> 8 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION B <br /> FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <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 SHORELI E. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY D <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF I HE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> f <br /> 6. <br /> NU) U)r- DE IV <br /> 7. <br /> 9 g.ii =.� $ m <br /> 9 D O !Q <br /> 8. a, <br /> 25'c m <br /> i o : ate : C <br /> o 9 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the basil of my � � <br /> knowledge and belief it Is true, correct and complete. I acknowledge that I am responsible for the detail and accu cy of m <br /> „ m �,': M <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I re gnize lE '• o o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining wheth to is- <br /> o ; 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 O p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances 0,other 3 2 <br /> authorized pars n to have access to the above described premises at any reasonable time for the purpose of Inspi ictlon. <br /> SIGN HERE <br /> N ; <br /> (signature of sier or building contractor) (date) o <br /> ell <br /> o i i <br /> ZONING ADMINISTRATOR 1 ` (.q <br /> �NN (nNNNN m <br /> TOWNSHIP PERMITS MAY BE REQUIRED i 0 0 0 0 N u, mo m <br /> 0000ggoooN <br /> TT <br />