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&A CO"), <br /> Burnett Cotintyr7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator Co w -0CD o <br /> APPLICATION FOR LAND USE PERMITS . <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work <br /> y <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> ^I c v 11 <br /> OWNER TELEPHONE <br /> / m � <br /> 4f <br /> HOME ADDRESS I � VV\ ,NUI�F, <br /> EMERGENCY/FIRE NUMBER a 3L-7 -7C) ROAD NAME Lr� rd-_1 6� <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CONTRACTOR IV n <br /> v f <br /> TYPE OF PERMIT(S): DWELLING/BUILDING--,X-GARAGE/ACCESSORY STRUCTURE-ADDITION- <br /> SANITARY <br /> TRUCTURE ADDITION SANITARY PRIVY FILLING/GRADING CAMPING UNIIT SUBDIVISION ,� <br /> STRUCTURE/ADDITION USE: �� �{/(/ �1 y <br /> oma/ bin; Commercial Business; Bedroom; Deck;etc.) <br /> A <br /> °r <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR (� <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) A <br /> -n 3 <br /> m P N <br /> 1. All required dimensions or distances to be shown or drawn to scale. n o n <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB) and indicate mo (/1 <br /> North (N). y O <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of m <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, <br /> roads, lake, lot lines. m <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. I <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be U <br /> signed and dated by the owner. W w <br /> A IQ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- 0 a <br /> FORE A PERMIT CAN BE ISSUED. yJ <br /> N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 2 J �� <br /> CONDITIONS OF PERMIT: 0 8 <br /> N <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 SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �J <br /> PERMITTED. I 1 p <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE t <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> 6. <br /> s mmv �s, > Fm <br /> 7. it U > <br /> M <br /> n am <br /> ' AoE k°,2 : : 1 <br /> 8. o = <br /> c <br /> a � z <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ' G>' <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> 9 P 9 P Y <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. I further accept all liability which may be a result of the County of Bumett relying on this Information I am nv <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 8 <br /> authorized person to have acess to the above des ribed premia s at any reasonable time for the purpose of Inspection. m 1 <br /> SIGN HERE <br /> (signature of r u con r) dela) <br /> S� o : : <br /> ZONING ADMINIST TOR ` E [ f '• <br /> 7»Fw Fn�vi Fn ei� <br /> � MN .oNioc,NiiNaNio <br /> TO SHIP PERMITS MAY BE REQUIRED <br /> 00 $$ $ $$ y <br />