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6n <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS w 3. <br /> e n <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work N <br /> described and located as shown herein. The undersigned agrees that all work shall be done in accor- <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 d <br /> OWNER D. �LIE.� TELEPHONE <br /> HOME ADDRESS <br /> a7�si L EBF kit,: S�f�i� C <br /> EMERGENCY/FIRE NUMBER ? N6_1 <br /> ROAD NAME <br /> A9/'0- / 323/307 ilaal33 535/1 y0.t?/5l4/ACRES .G9d <br /> LEGAL DESCRIPTION(see tax receipt) a--s(O-/5-35' O O/ 00. <br /> Lnrz C'SN ✓3 �i7s (Z.VGadLdT1!) <br /> CONTRACTOR (�LF <br /> J O <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTUREADDITION <br /> N <br /> O <br /> SANITARY PRIVY FIL <br /> LI <br /> N <br /> G <br /> / <br /> G <br /> RADINGCAMPIIN�NJGUNIT ./-.SUBDIVISION- <br /> STRUCTURE/ADDITION USE: h6� �` ,�/GI//'�i /� �L} o 4 <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. r <br /> O <br /> x <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> T ? (n <br /> T o a <br /> 1. All required dimensions or distances to be shown or drawn to scale. <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB) and indicate m o <br /> North (N). C = <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) building(s)to centerline of m <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. U <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. y <br /> iQ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. ! ` <br /> 2 W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. U� <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 /> N N N D D <br /> s ° Cv =<' � �8an Im <br /> 7. A _ <br /> 2 <br /> cy o <br /> N <br /> Z f _!y: <br /> B. o — <br /> c�2 m <br /> m m <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the best of m ' G) M <br /> PP ( 9 Y ) Y Y <br /> M <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> yr m in : O <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize opo o <br /> i 6 !D 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 O o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other j 3 <br /> authorized person to have access to the above des c ed premises at any reasonable time for the purpose of inspection. m m <br /> � H <br /> SIGN HERE '"Zt"e'2� 2 <br /> N ; <br /> ( n re of ow er r building contractor) (date) o <br /> o ; <br /> ZONING ADMINISTRATOR �'1 . o <br /> F»e>�F»e3 to j' n <br /> N N T N N N <br /> Mm <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> r"' <br /> 00000006) <br />