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OA ( � <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Adminis>rator W f o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work � 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 /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. N <br /> c <br /> OWNER J;r L1° .C� TELEPHONE o m' <br /> HOME ADDRESS <br /> P o . fib- We bst� 8 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> rb <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CONTRACTOR1 e p Q— <br /> �. <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION 0 –1 <br /> y � r <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONS <br /> ryX o C <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 4, <br /> A � C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O a <br /> -n p c <br /> T Z o <br /> 1. All required dimensions or distances to be shown or drawn to scale. n P — a <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB) and indicate m 9�p y. <br /> North (N). m n <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. w 3 <br /> 4. Show the location of the well (W), septic tank (ST) and drainfield (DF), and all distances to buildings, I w <br /> roads, lake, lot lines. <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. 991 (7�s C — <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be JQ 9J <br /> signed and dated by the owner. r!; <br /> WQ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION E E- o <br /> FORE A PERMIT CAN BE ISSUED. Q) <br /> r <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. - <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMI <br /> ISSUANCE. Cj <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELI 4E. <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 /> o c �m jn a F o -o <br /> M v� 2 nn m <br /> 7. m n n N c <br /> 'O N O <br /> Z <br /> 8. P – m <br /> �€ jai <br /> n ` p <br /> o : ice ; C <br /> o <br /> m <br /> 1 declare that this application (Including any accompanying schedule) has been examined by me and to the bet of my G) <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and ace iracy of <br /> , o o nize oo <br /> all information contained in this application(including an accompanyingschedule)and I further declare that 1 <br /> o : <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whett or to is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this informal on I am n o [ <br /> providing in this application. I agree to permit county officials charged with administering county ordinances 3r other 3 `� <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Insp action. m ? ; H <br /> H <br /> SIGN HERE <br /> N <br /> (signature of owner or building contractor) (date) o <br /> ZONING ADMINISTRATOR 71iff, Flanlao <br /> 1'�NNtn NN NN m <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 o m <br /> 00000000N <br />