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r7 <br /> BurnerttCounty 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator m 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work y <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 all other » <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. ov <br /> a (? �! <br /> OWNER TELEPHONE <br /> HOME ADDRESS L O <br /> L(Oo $ lut)Oc( �-n ^.'K�t 3'S`r 9L Ll �A <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) G a L16 dj 335 $ 7L/o y0 -17-17 -O 0/2 r0 <br /> 10i S'Tna y SEA, 4CTT I.I. <br /> CONTRACTOR �'Shic�:S 4Y�'rk jr v <br /> G) <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION 0 <br /> N .0.. <br /> O <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION J` <br /> 0 <br /> v <br /> STRUCTURE/ADDITION USE: G 4 b. Xa L/ ( j CD <br /> CD <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) O <br /> r <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR o <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In �) I <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 J" Q <br /> ,t 'P U O <br /> 1. All required dimensions or distances to be shown or drawn to scale. n o FL <br /> 2. Show the location and size of all existing buildings(EB) and all new buildings (NB)and indicate m y <br /> North (N). C <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, Ut1J <br /> roads, lake, lot lines. i <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 must be <br /> signed and dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> N <br /> O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <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 ? <br /> PERMITTED. JO 70 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 FEET OF THE r <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> jr <br /> a�tnvCnr> > <br /> 7. s o, a W g8 $ m <br /> CL <br /> <, <br /> 8. i f ' i Tit <br /> ° � » m <br /> m . <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my G7 i <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ' ` ; �'m 8t: p <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize c m o <br /> o , o : <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 Burnett relying on this Information I am v <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> 3 E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. -n m y <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) c <br /> o <br /> ZONING ADMINISTRATOR 4E4 � E E E '• <br /> ��3Po3 <br /> Fob <br /> NNcriNMN NtnNNNfJt mTOWNSHIP PERMITS MAY BE REQUIRED O v, 01 p N N vt OSSB$ $$oCa <br />