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0)q Clump , <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m -- 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit forte work N 0 <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- `D ` <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other 3 a d <br /> 0 <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y m <br /> 0 <br /> OWNER � IZ— �(/e/O j;,e J4 TELEPHONE 61z <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER 75� ROAD NAME - <br /> v <br /> n ,SCTio�t/ I <br /> LEGAL DESCRIPTION (see tax receipt) <br /> � <br /> SS/CWi t 7-14ff✓ /6 <br /> CONTRACTOR <br /> o <br /> �1 <br /> �y" � o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ` GARAGE/ACCESSORY STRUCTURE ADDITION »- <br /> N O <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> — <br /> Z a <br /> O 1 O <br /> STRUCTURE/ADDITION USE: ���� �S / 1UU noct e✓l1 <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. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) ° ISN <br /> 0 3 <br /> -n a y <br /> 1. All required dimensions or distances to be shown or drawn to scale. o a <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings (NB)and indicate m )j N: <br /> North (N). y O ° <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. I <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. u� <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 r <br /> signed and dated by the owner. c <br /> a. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATIONBE- <br /> FORE A PERMIT CAN BE ISSUED. B ' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. M <br /> CONDITIONS OF PERMIT: o <br /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMI <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELI 4E. <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 tLAKES, PONDS, RIVER UNLESSppSPECIFICAL,4Y PERMITTED. <br /> 5. SYGt Ir�+ e ra l✓O !nlSlGi� 4'412 hCS$u,c �y<fPms , <br /> 6. <br /> mrnvrnr- D F <br /> 7. <br /> O '.0 <br /> 8. a F ' i <br /> N c m <br /> A <br /> o : iii : C <br /> m m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the bet of my ' 0 73 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> 9 P 9 P Y <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize [ o 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. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am O p <br /> providing in this application. I agree to permit coun officials charged with administering county ordinances or other i 3 <br /> authorized person to have access to the bo de premises at any reasonable time for the purpose of ins ection. m ? y I <br /> SIGN HERE <br /> N <br /> gnat roof owner u Ing contractor) (tlale) o i i <br /> ZONING ADMIN ATOR �' <br /> OCT 2 6 I 5 919,0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o o" o N ps <br /> . <br /> 61 W f3C/77- <br /> --- <br />