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07 ee-9), <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m _0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> d o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work 2 y <br /> described and located as shown herein. The undersigned agrees that all work shall be done in accor- <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. ffi m <br /> OWNER TELEPHONE <br /> H,'gf, �. 53c)S7o <br /> HOME ADDRESS <br /> SAS �� n A /!�. <br /> EMERGENCY/FIRE NUMBER f--- l 4� ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) `1 C/ <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION <br /> N <br /> O <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION <br /> - <br /> Z $ <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Co mercial Business; Bedroom;Deck;etc.) <br /> CT <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. m <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> m a rn <br /> T Z g <br /> 1. All required dimensions or distances to be shown or drawn to scale. 3 P <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB)and indicate In <br /> North (N). y 0 n <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 /> 1 <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. n <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be K <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 /> 2.0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 2 <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 ? <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 /> o c' Nto iu D0 -0 <br /> AOE : a;Z 1 <br /> 8. o F i , E N; [ M <br /> N cit m <br /> o : ate : C <br /> Q: m <br /> I declare that this application (including any accompanying schedule) has been examined <br /> by me and to the best of my 0 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of E T � O <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- S i S <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 p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ' 3 ` i4 <br /> 3 : x: <br /> authorized person to have access to the above described premises at any reasonable time for the purpose ofd/Inspection. <br /> Y a N <br /> ` N i <br /> SIGN HERE <br /> v (signature of owner building contractor) L Ota) C�^;' <br /> ZONING ADMINISTRATOR it o ` <br /> (per: <br /> -Mn <br /> TOWNSHIP PERMITS MAY BE REQUIRED4: i•,` o m u o o m N o m <br /> 88 108088 '06) <br /> 000000 (/1 <br />