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oatoy <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m ; 0 0 <br /> APPLICATION FOR LAND USE PERMITS w 3. <br /> z <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work � u <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 3 <br /> 0 <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> OWNEi ,(JY7le TELEPHONE /S G ;26p aJ <br /> HOME ADDRESS O lm <br /> EMERGENCY/FIRE NUMBER ROAD NAME >Q✓` <br /> LEGAL DESCRIPTION(see tax receipt <br /> CONTRACTOR <br /> v r--y <br /> W O O <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE—ADDITION-4— o <br /> � r <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> oa° <br /> I / � <br /> STRUCTURE/ADDITION USE: I im Ail, = <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. m <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 <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 North (N). to o <br /> 3. Show dimensions in feet of the following: (a) buildings)to all lot lines, (b) building(s)to centerline of m I <br /> road, (c) building(s) measurement to the ordinary high water mark (OHWM) of lake, stream or river. 0 <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. w <br /> 2 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION I E- ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> 2. <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 {ter <br /> ISSUANCE. C\ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELI SIE. <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. \ <br /> 5. <br /> 6. <br /> (n U) � rnr D DD <br /> 7. lI ;�o 4e r /�CX6C TC rh /s �SS ��o^.' D O l /� f� ��w a s� Ram M _ <br /> n L / m G N. `z N Nm <br /> s. f��C — 1u7 L,lti/� /0/'Cor / ) ? Fv+i _`�n M <br /> m <br /> -- — o f i 5 i C <br /> o Ram <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the bet of my ' , m <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and ace iracy of ` C3 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whet er to is- 00 <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 n <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> 3 i x . <br /> authorized person to have access to the above deyaribed premises at any reasonable time for the purpose of Inspection. <br /> a m : <br /> V M <br /> SIGN HERE V d' <br /> (ai atu of Kner or bulldinIII co ctor) (date) o <br /> $ : <br /> ZONING ADMINISTRATOR 41 <br /> N N N N N N U <br /> TOWNSHIP PERMITS MAY BE REQUIRED 4p u, v, o N v, NP m <br /> 00000000 <br /> 00000000N <br />