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07L ,4o WW, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Adminis rator m m -- 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <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 in i ccor- `= ` <br /> dance with the requirements of the Burnett County Land Use Ordinance, Sanitation Code,and with all other 3. <br /> 0 <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y m <br /> OWNER rn (- -�h TELEPHONE <br /> (1 <br /> J- <br /> HOME ADDRESS D e ?S �, -7-7, r�/�r W_L Q <br /> EMERGENCY/FIRE NUMBER ROAD NAME I <br /> LEGAL DESCRIPTION(see tax receipt) N L N LQ <br /> V 1 �l 71 3_ Ll I <br /> — I <br /> - 1 <br /> CONTRACTOR X <br /> r - n <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION 0 <br /> N <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION � <br /> STRUCTURE/ADDITION USE: �� V • ' ✓ I�� I <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 C R <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O B <br /> Ta <br /> Z g v : <br /> 1. All required dimensions or distances to be shown or drawn to scale. n P <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB) and indicate m o <br /> North (N). to _ IT <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) building(s)to centerlini.of m 1 1 <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. J' <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. Z <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. C� <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans musl be _0 <br /> signed and dated by the owner. (n <br /> 2 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BZ-- <br /> FORE <br /> -FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMI L r <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 UNLESS SPECIFICALLY PERMITTED. (, <br /> 5. <br /> 6. <br /> n N V N D D O m <br /> a0Q < � � 8i m <br /> 7. A <br /> a� "_ x <br /> n aZ: y^ �yo � 3 <br /> w < N Q o =0 <br /> N O P-Q —1 <br /> -j f J T(n <br /> 8. o — m <br /> o : ate ; C <br /> o ; <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my �` [ � [ ; m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize Pon <br /> 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 relying on this Information I am 0 p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 2 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. fpm i ; N <br /> SIGN HERE w <br /> FA <br /> N ; <br /> (signature of owner or building contraetor) (date) <br /> ZONING ADMINISTRATOR <br /> N N N N N N N <br /> TOWNSHIP PERMITS MAY BE REQUIRED o v, v, o u, v, u, om m <br /> 00000000 <br /> 00000000 (A <br />