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V I 1 l <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator N - z <br /> CD 0 <br /> Y APPLICATION FOR LAND USE PERMITS . <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work Q o <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. H w <br /> OWNER / Jft <br /> /^� s� c m <br /> TELEPHONE �j/49 - y S- d CD <br /> j <br /> tbro� j6ke vie ,gyp i <br /> HOME ADDRESS �7�Sy /)Q � <br /> `T /'S' ss 3� JI'✓ <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) /w��7� o S 3?/fR'r6--e'j <br /> �L:�1 3�-1s�O5lJ.0a�sdD /r E 'S AD/� <br /> CONTRACTOR <br /> yylJ l�lf/ o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION 0� <br /> W O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> Z <br /> �,,� > CD <br /> $ <br /> STRUCTURE/ADDITION USE: SGLE� TOi�Q/�C(,h� 4 <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) <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. T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> O 3 <br /> m 'P � <br /> 1. All required dimensions or distances to be shown or drawn to scale. 0 o <br /> 2. Show the location and size of all existing buildings(EB)and all new buildings (NB)and indicate m y: <br /> North (N). y I <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, C <br /> roads, lake, lot lines. CSOr <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. .Ci) I <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be I V <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 /> 0 <br /> cf— <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> tll � <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 Z <br /> PERMITTED. 70 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. UI <br /> 5. <br /> 6. <br /> rnrn _Vrnr D0 '0 <br /> o,c M w <br /> 7. F,3 ami <br /> m <br /> o : dam ' A <br /> mom ; C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ' m m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o 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 ? o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other w rg <br /> authorized person to have access to he above described premises at any reasonable time for the purpose of Inspection. T m <br /> SIGN HERE <br /> ( Ig atur r or building contractor) V, oo <br /> L` 9U~ — ,, : o . E <br /> ZONING ADMINISTRATOR - E 0 , <br /> to roCA ro r1a"Cn �1 <br /> N N U 1 N N N U 1 m <br /> TOWNSHIP PERMITS MAY BE REQUIRED , <br /> 0000 g o 0 o m <br />