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ag i <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator » 6 <br /> APPLICATION FOR LAND USE PERMITS - s <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work v y <br /> described and located as shown herein. The undersigned agrees that all work shall be done inaccor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other o <br /> applica7/ ci� <br /> ty Ordinances and the laws and regulations of the State of Wisconsin. m <br /> K <br /> OWNER Ly� �6m�-,�h) TELEPHONE lq�� / tSS m <br /> lll��� r � / m <br /> HOME ADDRESS ✓`/p/0{ („^ <br /> � <br /> EMERGENCY/FIRE NUMBER a$�/� ROAD NAME II)C.(L�)aZIE Ili <br /> LEGAL DESCRIPTION(see tax receipt) S /7-7}o he /y to AC.2cS , as o �8A1l1 o��aT`S;fKj, a <br /> /o entc9e wl�n+ Fsmr 4 3 � z <br /> CONTRACTOROrAt12 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE V ADDITION = g <br /> y O <br /> O <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION- <br /> STRUCTURE/ADDITION USE: C­),4124GE /lofT <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. T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 <br /> T c� <br /> T G <br /> 1. All required dimensions or distances to be shown or drawn to scale. R. <br /> 2. Show the location and size of all existing buildings(EB)and all new buildings (NB)and indicate m �L) <br /> North (N). U) l <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. K <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. O <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be l U x <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 /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> 3. <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 <br /> PERMITTED. _ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE <br /> OHWM OF LAKES, PONDS, RIVER UNLEj�S�SSPECIFICALLY PERMITTED. <br /> 5. OC)AA /u V <br /> V F <br /> 6. [ p <br /> m <br /> 7. <br /> m m<; : wQC o53 <br /> = f TI en <br /> 8. P � : = m <br /> u : € �g E O <br /> m " C <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my ' E m <br /> knowledge and belief It is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of E �;'m <br /> all Information contained in this application(Including any accompanying schedule)and I further declare that I recognize E o me o <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 retying on this Information I am p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other , 3 ? � <br /> authorized person to have scoots to the bed premises at any reasonable time for the purpose of inspection. T E '; N <br /> SIGN HERE <br /> signtun or ow r building contractor) II 1 =-Idata) [ g E E <br /> ZONING ADMINISTRATOR <br /> I +NNfnNNNNm <br /> TOWNSHIP liERIMITS MAY BE REQUIRED i I 1 J o v u o o .0 v, 00 <br /> �� :; ggggoggolmll <br />