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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administkator m m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work <br /> � y <br /> described and located as shown herein. The undersigned agrees that all work shall be done in ccor- <br /> 3. <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 /> 1I ( n <br /> OWNER ��C�IaE' F+�i�— TELEPHONE p m <br /> m <br /> HOME ADDRESS Z G <br /> I <br /> EMERGENCY/FIRE NUMBER ROAD NAME Z n <br /> LEGAL DESCRIPTION (see tax receipt) c. <br /> CONTRACTOR "1bm Ski o (VNOr g <br /> � O <br /> <- <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION 6 (o <br /> N O <br /> O <br /> SANITARY PRIVY FILLING/GRADING ///CAMPING UNIT SUBDIVISION <br /> Csfn <br /> STRUCTURE/ADDITION USE: � <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 /> z <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 A <br /> 'n z QO <br /> T <br /> 1. All required dimensions or distances to be shown or drawn to scale. m o nF- <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB) and indicate C 0_ <br /> North (N). to <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerlir a of m ) <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 buildi rigs, <br /> roads, lake, lot lines. <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. 1 <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans mu t be d <br /> signed and dated by the owner. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION EIb <br /> - <br /> FORE A PERMIT CAN BE ISSUED. N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMI C <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 9 <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 /> 6. L0+5 ( eaA/, -t— be Lt30cLn� ���e v� � <br /> �(.L I l C41•�.N„ c1- J�"rl.-C-/Lt�e S _ vi rn v v> >n>71 <br /> 17 <br /> �U 6w SLIIICtbf-e— �pr cCGCSS Z,N lic J D <. : Cv' � <br /> ll a <br /> F, 74 <br /> 74 <br /> �a t✓I�7 oNl * ' i 1 _ � : : <br /> 8. P [ d : m <br /> 10 <br /> o n� i C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myi y i : <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of 1o <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I cognize o m o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whet or 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 0: o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of In pectlon. m . <br /> A N <br /> A <br /> N t t <br /> SIGN HERE <br /> N ; <br /> (signature of owner or building contractor) (date) o . <br /> o i i <br /> o : <br /> ZONING ADMINISTRATOR :ZT" ' <br /> N N U N N N N in <br /> Orli V+ ONNNO <br /> m <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 00 0 (A <br />