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Burnett County 7'410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator (n 0o 0 <br /> APPLICATION FOR LAND USE PERMITS Z2. 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for ft work <br /> described and located as shown herein. The undersigned agrees that all work shall be done inaccor- 3 a <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with a I other - <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y d <br /> � m <br /> OWNER 14-'10 EN�, C_ P�ro�t.nt� `TELEPHONE 7 <br /> HOME ADDRESS N� L Dq"7J Q rl.y I �I` <br /> r r 6 IC- <br /> EMERGENCY/FIRE <br /> EMERGENCY/FIRE NUMBER ROAD NAMEt <br /> LEGAL DESCRIPTION(see tax receipt) SOT [ O(Sror,! I iia ( o� Q ec f_g- <br /> SRT t�IV DEVI RFI Ti 4,6V <br /> CONTRACTOR sA•N�fE1 <br /> 0 <br /> � O <br /> TYPE OF PERMIT(S): DWELLING/BUILDING_ X GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION- <br /> Z <br /> - o <br /> STRUCTURE/ADDITION USE: `[ 'om(F 04-(Cie- f4'mroic <br /> (Home/Cabin; Commercial Business; Bedr om; Deck; etc.) <br /> r <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE O <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) A <br /> O v W(Y) <br /> 1. All required dimensions or distances to be shown or drawn to scale. n o n <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB) and indicate m y. <br /> North (N). c <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerlin of An <br /> r <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, �1 <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. <br /> I y <br /> iQ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. S <br /> o I� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. � O <br /> CONDITIONS OF PERMIT: o <br /> N � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. `f <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Au z <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OFT E <br /> 5. OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. o� <br /> JFXlsfi S0- "e (- I!v cid /vowcn a.M s f6odk �� be rerna <br /> 1 wrfl1�la w / y su r�P '��7� <br /> 6. - CIJSes/ �(Jr r r 7'7-6r elyy <br /> �a0 6ac�l- hors / 4�¢ S.ac pn.cor�J toca�T S '� e'V <br /> C�firn.er v <br /> 7. O CM.N N 8 ELLD D O ELM <br /> S LfdAc / 6 r A10 AF-A °fes a o g a Tr <br /> 8. [ /I/c, <br /> 'ja , o f [ <br /> ( ' .'3 57//,e/fe - �I/ U/SiaN o s n Com`f �'✓'°.� /V <br /> m <br /> u : �2 <br /> of : nom ' C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best f my G> <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and aecura y of �m N p <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I reco y of E om o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether o ze <br /> 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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 03 $ <br /> m : <br /> authorized person t e access th a described premises at any reasonable time for the purpose of inspec ion. m 3 F <br /> SIGN HERE - <br /> gn ure of o/ or r ullding contractor) I (date) o ` <br /> ZONING ADMINISTRATOR <br /> TV <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N o N N o mmr <br /> 000000 o yR <br /> ��—ami <br />