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W 0 7 J <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator � 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 0 <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 inccor- `= <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other 3 0 <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> — g O <br /> OWNER �— TELEPHONE -74ap,on <br /> m <br /> m <br /> HOME ADDRESS a oH, 3�flhtay, <br /> EMERGENCY/FIRE NUMBER ROAD NAME _I <br /> LEGAL DESCRIPTION(see tax receipt) c� 1 <br /> CONTRACTOR ri3( se _ �Sv rve p <br /> m O <br /> n o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION 0 <br /> N 0 <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> Cs of ° <br /> - <br /> STRUCTURE/ADDITION USE: 5 P 83- <br /> � <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 CR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> -n a Cn <br /> T Z c <br /> 1. All required dimensions or distances to be shown or drawn to scale. m a <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB) and indicate <br /> North (N). (a <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) building(s)to centerlin B 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 mus be <br /> signed and dated by the owner. n <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. <br /> 2. <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 PERMI <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF HE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> F <br /> 6. <br /> ex °a Wa�aFm <br /> 7. � R, °i cu", oS � <br /> 3o <br /> Z f ' = m : M <br /> 8. ' I G�2 m <br /> D <br /> o ate ; C <br /> 0 : ° m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the bet of my ' O : m <br /> ;y : i <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of O <br /> o� : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o <br /> � o m o E <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining wheth r to is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this informat n I am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other E 3 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of lnsr action. qm ? E N <br /> SIGN HERE w <br /> N <br /> (signature of owner or building contractor) (date) o <br /> �1 ; o i <br /> ZONING ADMINISTRATOR E <br /> M <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 o No 0 0 o m <br /> 00000000N <br />