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11? &'Y4, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m - 0 0 <br /> APPLICATION FOR LAND USE PERN ITS 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work <br /> described and located as shown herein. The undersigned agrees that all wi irk shall be done in actor- 3 <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanita ion Code,and with all other o <br /> applicable County Ordinances and the laws and regulations of the State of W sconsin. y m <br /> c m <br /> OWNERTELEPHONE _ 7ss= 7 m <br /> HOME ADDRESS /) 3*, <br /> , <br /> ry 0�-n <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> �c L <br /> LEGAL DESCRIPTION(see tax receipt) � se� rP 1 <br /> a � � <br /> CONTRACTOR <br /> o <br /> TYPE OF PERM IT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> = r <br /> 0 O^ <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> a o <br /> v <br /> m <br /> STRUCTURE/ADDITION USE: f <br /> (Home/Cabin; CoiAmercial Business; Bedroom;Deck;et .) <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 /> ;a ii T_ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) p 0 <br /> T P en <br /> n o a <br /> 1. All required dimensions or distances to be shown or drawn to scale. n <br /> 2. Show the location and size of all existing buildings (EB) and all new buildin s (NB) and indicate mH' <br /> North (N). w <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of m <br /> I <br /> road, (c) building(s) measurement to the ordinary high water mark (OHWi 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, ))? d <br /> roads, lake, lot lines. lyy! — <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. 1 <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. U n <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEE- <br /> FOREA PERMIT CAN BE ISSUED. (y <br /> N II ''11 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: R <br /> N 1n <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 50 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTE ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ? <br /> PERMITTED. ( n <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. (f�' <br /> 5. <br /> f <br /> 6. <br /> X <br /> o c d A $ f m <br /> 7. N `2 tNt� 0,0 =f0 <br /> N O \`2 1 <br /> Z F = 71 . <br /> o : 31 <br /> 8. <br /> N c '= m <br /> o : a <br /> 1 declare that this application (including any accompanying schedule) has been examin d by me and to the best of my '• , m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsib a for the detail and accuracy of <br /> PP (including Yaccompanying ) g E on o : <br /> all information contained in this application includin an schedule and further declare that I reco nize o m g <br /> that this Information I am providing will be relied upon by the County of Burnett Wiscons n in determining whether to is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett elying on this information I am n p <br /> providing in this application. I agree to permit county officials charged with administer ng county ordinances or other 3 2 <br /> authorized person to have access to the above described premises at any reasonable tim for the purpose of inspection. r H <br /> B y : <br /> SIGN HERE N i <br /> ( f owner or building contractor) (date) [ o <br /> o <br /> ZONING ADMINISTRATOR 1,17-1 <br /> EnF»� -t <br /> N N N N N N m <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 0 it <br /> o0000000fn <br />