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V r t <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 01 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work Z <br /> N <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. c <br /> OWNER � ' TELEPHONE <br /> `m � pr (cid- 73/-C7E/ d <br /> HOME ADDRESS <br /> & I„_ J—. y l a �!�I?S <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> e4k O - <br /> LEGAL DESCRIPTION(see tax receipt) 6-31 <br /> M <br /> \\ <br /> CONTRACTOR <br /> o <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> H r <br /> 0 <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o � <br /> STRUCTURE/ADDITION USE: CgL:ln <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. r <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> T P rn <br /> T o a <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 <br /> North (N). w .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. lQj <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 <br /> signed and dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ( Q ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o �1 <br /> CONDITIONS OF PERMIT: a <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT )N <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ( V <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 7z) ? <br /> PERMITTED. n <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> 6. San( l �u� <br /> cnD y <br /> o,c �. <br /> 7. R <br /> Tom ; ZI <br /> 8. o <br /> m <br /> C i D <br /> 8: a5 : C <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m ` G) <br /> PP ( g Y ) Y Y <br /> knowledge and belief it Is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of '• `^ d" 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 m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- <br /> o ; 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 am O p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person have access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE <br /> ( gn <br /> ]reo er or builtling contractor) (date) [ o [ <br /> o : <br /> ZONING ADMINISTRATOR <br /> N N N N N N N m <br /> TOWNSHIP PERMITS MAY BE REQUIRED o v u o n v u o m <br /> $ $ o $ 0000fn <br />