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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator elN ( M'/2-I 2 <br /> APPLICATION FOR LAND USE PERMITS 3. o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work g <br /> described and located as shown herein. The undersigned agrees that all work shall be done inaccor- <br /> dance with the requirements of the Burnett County Land Use Ordinance, Sanitation Code,and with all other - <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. H d <br /> OWNER <br /> rJ/ V/ � � TELEPHONE o v <br /> 0 <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER C/��r R - <br /> ROAD NAME &on's, b)6 <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> / o <br /> 2 o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION � '� < <br /> N r <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNITo <br /> SUBDIVISION Z � <br /> P a <br /> STRUCTURE/ADDITION USE: �(T /A) j9,,-0 //ji�� 10" <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) r <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. <br /> r <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> O 3 <br /> 1. All required dimensions or distances to be shown or drawn to scale. n o a <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB) and indicate m r y <br /> North (N). C 0 <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) building(s) to centerline of m I <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, <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 v, <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE <br /> FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. I� <br /> CONDITIONS OF P RMIT: o <br /> W � <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 z <br /> PERMITTED. D <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OFT E <br /> 5. OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 6. <br /> 7. o c m m Da C <br /> m m5. i dCuNi o5 <br /> 0. o ? � o o <br /> 8. <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best o my ' iI; m <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accura of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recog ize u, <br /> o� o : <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether t is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or cher n 8 <br /> f1 : 3 <br /> authorized person to have as to the above ribed premises at any reasonable time for the purpose of inspect) n, m ? ` 3 ' F <br /> m w <br /> g atu of owner or build ntractor <br /> 1 <br /> ZONING ADMINISTRATOR <br /> t»F»� -n <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N N N N N N m <br /> _1 O Vl N O P N N O <br /> I { <br />