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N e / <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Adminis rator ,� ; 6 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work <br /> describld and located as shown herein. The undersigned agrees that all work shall be done in iccor- `g <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. H » V \ <br /> r .{ t' TELEPHONE / _ 5'y _ ,� c-7 cxo <br /> HOME ADDRESS Ch P /V <br /> EMERGENCY/FIRE NUMBER O 7 ROAD NAME,h <br /> F�^1 <br /> LEGAL DESCRIPTION(see tax receipt) •� L0 <br /> CONTRACTOR ' v, p <br /> 'm O <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION <br /> y O <br /> O <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION 1 <br /> STRUCTURE/ADDITION USE CL(ib i /! <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 OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) p 3 <br /> T v rn <br /> T Z i <br /> 1. All required dimensions or distances to be shown or drawn to scale. <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB) and indicate m VJ <br /> North (N). m ' <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) building(s)to centerline 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, <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 must be Q r <br /> signed and dated by the owner. cn <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATIONBE- <br /> FORE A PERMIT CAN BE ISSUED. _ <br /> 6 rZ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <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 SHORELI qE.. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <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. �I <br /> 5. <br /> 6. /O -/O -� S 2 T2C C1 . /��� SQ F��cI�S 4pioin-0 1P 1.P "41J. LLL� <br /> 8 a * m <br /> 7. <br /> o am » <br /> 8. �C'SC� c�2 Inc <br /> In <br /> o <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the b t of my f i m <br /> �� �: <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of S m N O <br /> PP (including Yaccompanying ) recognizet o�c o ; <br /> all information contained in this application ineludin an schedule and I further declare that I <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to le- 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 ami o i <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ; 3 i4 i <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. m ? H <br /> SIGN HERE <br /> (signature of owner r builtling contractor) (date) F2 o <br /> i o <br /> ZONING ADMINISTRATOR1/ i <br /> OCT6` 995 �� m <br /> VI U I�.7.J NNtINNNN m <br /> TOWNSHIP PERMITS MAY BE REQUIRI q o u u N o <br /> i - o0000000 fm/1 <br />