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gin.l n ' <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator w m o 0 <br /> 2. <br /> APPLICATION FOR LAND USE PERMITS 5 3. <br /> Q <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work M y <br /> described and located as shown herein. The undersigned agrees that all work shall be done in 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. y m <br /> OWNER u - c TELEPHONE �3 0 <br /> su <br /> m � <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER / ROAD NAME <br /> U r <br /> LEGAL DESCRIPTION(see tax receipt) f <br /> CONTRACTOR - , _ p ✓� <br /> m 0 <br /> o <br /> TYPE OF PERMIT(S): DWELLINGIBUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> m °r <br /> o � <br /> SANITARY PRIVYFILLING/GRADING-CAMPING UNIT SUBDIVISION o a <br /> STRUCTURE/ADDITION USE: <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. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> T a m <br /> T Z c <br /> 1. All required dimensions or distances to be shown or drawn to scale. m o a <br /> 2. Show the location and size of all existing buildings(EB) and all new buildings(NB) and indicate o <br /> North (N). m I U ' <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) building(s)to centerline of 5. i <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. ¢ <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. p <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. )i <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. co <br /> R <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION E E- <br /> FORE APERMIT CAN BE ISSUED. r-r <br /> N9° <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITr� <br /> ISSUANCE. A) <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELI 1E. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY D <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF rHE � <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> f <br /> 6. p <br /> m <br /> 7. � <br /> CvO S � <br /> P <br /> f ' I TN <br /> 8. D <br /> jj <br /> EF : <br /> m m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the bet of my y ii m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and acc iracy of <br /> o : <br /> all Information contained in this application(Including any accompanying schedule)and I further declare that I om cognize b m o ; <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whett er to is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this informat on I a 0 o E <br /> providing in this application. I agree to permit county officials charged with administering county ordinances Dr other <br /> ,uthorized person to have access to the above described premises at any reasonable time for the purpose of Insl action. m . <br /> R N : <br /> IN HERE ` ^� <br /> (signature of owner or bull g contactor) (date) <br /> NING ADMINISTRATOR <br /> e>i,=' -t <br /> NN (n NNNUt m <br /> TOWNSHIP PERMITS MAY BE REQUIRED 00 0 0 0 0 0 0o m <br /> 00060000 U1 <br />