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D✓l Ce>�n�I <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator d _ -- 0 <br /> APPLICATION FOR LAND USE PERMITS d 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit forth z work � y <br /> described and located as shown herein. The undersigned agrees that all work shall be done in i ccor- 3 <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. 7Q? <br /> N w <br /> OWNER _ TELEPHONE <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER & AD NAME <br /> I R <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CONTRACTOR rn <br /> m � <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> N p <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNSUBDIVISION <br /> Z a <br /> ,�p(L/�� <br /> STRUCTURE/ADDITION USE: srn . I a , � fll <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 O <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) M 91 <br /> O 3 <br /> -n a Co <br /> n Z v <br /> 1. All required dimensions or distances to be shown or drawn to scale. n o 6 <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB)and indicate m C ) y' <br /> North (N). y ° <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. p a <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildings, i <br /> roads, lake, lot lines. Q <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. .9J <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. cn <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BI Q a <br /> FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. �O <br /> CONDITIONS OF PERMIT: o <br /> N <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. ) D <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 /> f <br /> 6. <br /> (n(nv (pr DD mo <br /> 7. m g c < 2. a 5 m <br /> g� a � - = x <br /> N M <br /> . o- 0 <br /> Z F `2 <br /> > <br /> 8. m <br /> o : o O <br /> s? : C <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m ' ` m <br /> PP (' 9 Y 1 Y Y <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of .1 gn', 8Z: O <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize <br /> PP (' 9 Y 1 9 0 � of <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 C>: p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances oi other 3 2 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. <br /> N N <br /> H <br /> SIGN HERE <br /> N ; <br /> (signature of owner or building contractor) (date) o <br /> o : <br /> ZONING ADMINISTRATOR <br /> r»e>F»�we3 r»� -n <br /> N N t I t N N N N m <br /> TOWNSHIP PERMITS MAY BE REQUIRED o u v, c) N 0 M o m <br /> 00000000rr) <br />