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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator c -0 o 0 <br /> APPLICATION FOR LAND USE PERMITS � -. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work H <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- m ` <br /> a <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. H <br /> OWNER pqy,o TELEPHONES ( Z_) +-4 A 3 3.-15jk <br /> \ S�t/�/SCD <br /> - <br /> HOME ADDRESS RO-CDE <br /> 10SO8 _15c.AO D AVE t1 BKr:oKG W PACK 111N S') 12) <br /> (— J <br /> c, p 0o V <br /> EMERGENCY/FIRE NUMBER � as I ROAD NAME 0/4K LA K C- K-C) <br /> C <br /> LEGAL DESCRIPTION(see tax receipt) Ld-r 1 es m J (C t7, [OS C�i_ L. O J(� ` <br /> 7— <br /> CONTRACTOR <br /> 4 /n <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE �DDITION 5 <br /> N <br /> 0 <br /> SANITARY PRIW FILLING/GRADING CAMPING UNIT SUBDIVISION— <br /> STRUCTURE/ADDITION <br /> UBDIVISION STRUCTURE/ADDITION USE: ST oFp,G I_ 5 H EZ� 41 <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. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> -n P m <br /> TZ <br /> F) <br /> 1. All required dimensions or distances to be shown or drawn to scale. P FLa <br /> 2. Show the location and size of all existing buildings(EB)and all new buildings (NB)and indicate y <br /> North (N). m C+o <br /> 3 .Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of <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, 3 <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. Cn <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 /> 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 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 /> f <br /> 6. <br /> �n rnvmr DF V <br /> C M. m n <br /> In <br /> 7. ry m dCno J ; <br /> kQ <br /> Z f <br /> 8. o FAE =__ m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my ; m <br /> knowledge and belief it Is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained In this application(including any accompanying schedule)and I further declare that I recogni �' 'oo'° 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 no f <br /> u <br /> Providing in this sAlcation. I agree to permit county officials charged with administering county ordinances or other , 3 , ig <br /> authorized pemo to Itave access to the above escribed premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE <br /> (sl r ure of r or building contractor) (date) + g [ <br /> ZONING ADMINISTRATOR g <br /> N N N N N N N m <br /> TOWNSHIP PERMITS MAY BE REQUIRED " n N u, o m <br /> 00000SooN <br />