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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Adminisil rator um o 0 <br /> APPLICATION FOR LAND USE PERMITS 2. <br /> w 3• -- <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit forth work 0 H <br /> described and located as shown herein. The undersigned agrees that all work shall be done in Icor- = c <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other 3 ig <br /> 0 <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> OWNER Mr Iat.L)Q.t--- TELEPHONE <br /> fill 50 <br /> HOME ADDRESSLn <br /> I v 9j �I <br /> EMERGENCY/FIRE NUMBER 30D ,'I r— ROAIID NAME� up, <br /> LEGAL DESCRIPTION(see tax receipt) tot 3 J,46 30-K;.; R I Uc✓St dR. ' 1 <br /> CONTRACTOR <br /> ° <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE'����,��'y�ADDITION 0 <br /> N n J <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o c° <br /> m <br /> STRUCTURE/ADDITION USE: L <br /> (Home/Cabin; Commercial Business;Bedroom; Deck; etc.) <br /> r <br /> o_ <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE CR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n <br /> O (}- <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> 'n a N <br /> n Z v <br /> 1. All required dimensions or distances to be shown or drawn to scale. p P O <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB) and indicate m i, N: <br /> North (N). a) ° , <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. n I <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildi gs, <br /> roads, lake, lot lines. <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. C� <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. U v <br /> ig <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION B - ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o — <br /> N <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 7173 7 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF I HE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> 6. 6r, <br /> o c 0 d n a mg m <br /> 7. mam g: m <br /> M m <; : 01 cH 057Z <br /> 8. G `L 7 TI N ; : ZI <br /> m <br /> c : <br /> o : 9 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the basil of my ' G) <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and aecu ae of m <br /> g P 9 P Y <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> o , o ; <br /> that this information I am providing will be relied upon by the County of BurnettWisconsin in determining wheth r to <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Informatic n I a c� <br /> providing in this application. I agree to permit county officials charged with administering county ordinances o other °1 ' <br /> 3 : <br /> authorized pars n have access t he above described premises at any reasonable time for the purpose of insp coon. m i i <br /> A N <br /> SIGN HERE a_ 146 _9 ' F^` '• <br /> N ; <br /> (signature of owner or eulltling contractor) (date). -_ [ i o l <br /> t <br /> ZONING ADMINISTRATOR e o <br /> TOWNSHIP PERMITS MAY BE REQUIRED o N N O N u WO m <br /> DEC 2 11995 <br />