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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ,� - 0 0 <br /> APPLICATION FOR LAND USE PERMITS w 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 work shall be done in actor- T <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. <br /> OWNER hn,e [ ,, / �tl TELEPHONE .715 8, /G 7 A�� p f. q <br /> HOME ADDRESS " S <br /> gv�sS w4y� s 3W69 3 <br /> EMERGENCY/FIRE NUMBER ROAD NAME �p Q 0 C U�t <br /> JJ n` <br /> LEGAL DESCRIPTION(see tax receipt) pC� �� sW Imp 5C /a AT S� <br /> CONTRACTOR 5' _ <br /> 0 <br /> R <br /> TYPE OF PERMIT(S): DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ADDITION <br /> y O <br /> O <br /> SANITARY-X--PRIVY FILLINGIGRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: J,� <br /> (Home/Cabin;Commercial B siness;Bedroom;Deck;etc.) l <br /> � O <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) p 3 <br /> -n 'R y <br /> Z c <br /> 1. All required dimensions or distances to be shown or drawn to scale. m P a -lit2. Show the location and size of all existing buildings(EB)and all new buildings(NB) and indicate H <br /> North (N). y <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of in t✓ <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. o <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. IW <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. �y <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. �C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- W <br /> FORE A PERMIT CAN BE ISSUED. N 93 <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. m <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT a <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATK3NIS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Z <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWiD WITHIN 75 FEET OF THE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> f <br /> 6. <br /> v, rnvrn� m <br /> < _ 8 <br /> ° W _ <br /> 7. m 2C00 <br /> O — ' <br /> 6. i Ni i Oc i i m <br /> C <br /> I declare that this application (including any accompanying schedule) has been examined by''me and to the best of my '• O m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of i i �{y N G <br /> PP (including Yaccompanying ) recognize <br /> all Information contained in this application meludin an schedule and I further declare that I 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 o <br /> providing in this application. I agree to permit county officials charged with administering coup ordinances or other 3 ` x <br /> P 9 � PP� 9 P tY 9 9 tY 93 y : <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. rym . <br /> SIGN HERE <br /> N ; <br /> (sl a r f ow r o ullding contractor) (date) o f E <br /> o : <br /> o : <br /> ZONING ADMINISTRATOR <br /> �NNNNtn <br /> TOWNSHIP PERMITS MAYBE REQUIRED Ib o 0 0 0 <br />