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ef� (W, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 3 ? o <br /> APPLICATION FOR LAND USE PERMITS w o <br /> UT <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 work shall be done in actor. 3 _ <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other o <br /> applicable ' KK(County Ordinances and the laws and regulations of the State of Wisconsin. A <br /> OWNER V )R `M t/` kD-r� TELEPHONE <br /> YYYY���µfir.. f� ly <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER Sj ' I U ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR ,hl 12�L h� I k OT7 , O <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION H o <br /> 0 <br /> v <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> m <br /> STRUCTURE/ADDITION USE: vl o D s 11 t V <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <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. 0 <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 'R v, <br /> n Z c <br /> 1. All required dimensions or distances to be shown or drawn to scale. m P <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB) and indicate O <br /> w <br /> North (N). M <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of � e <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. <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. <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. J <br /> QQQ iQ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. . <br /> 2. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITION$ OF PERMIT: � (� GG\\ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT IU <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Z <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 THE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> 6. <br /> o c -.m m <br /> S c ?.nN m <br /> 7. m oaf � yono3 <br /> O < <br /> N <br /> F O >D Z <br /> G O _ to: m <br /> v[ @ m <br /> 8. a O <br /> o E C <br /> o i <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my i m : i <br /> , l M� m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ; o o <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize ? o m o <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 w 0 <br /> providing in this application. I agree to permit county ofFlc' charged with administerin county ordinances or other i 3 '. <br /> 9 ty o N : <br /> authorized person to have access to the above describe remises at any reasonable time for the purpose of Inspection. m <br /> W \ 1 •` i 1 H E9: <br /> SIGN HERE ro <br /> (signature of owner orb Iding onbactor) (date) <br /> __J � E of i <br /> ZONING ADMINISTRATOR d' d' <br /> m <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0004 0 0 0 0 com <br />