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V, l 6 / <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administ ator d _0o <br /> APPLICATION FOR LAND USE PERMITS 6 3. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work <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 o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> OWNER Ve TELEPHONE7�� <br /> HOME ADDRESS ' /j,' <br /> EMERGENCY/FIRE NUMBER y ROAD NAME 'lly /� <br /> i/ <br /> LEGAL DESCRIPTION(see tax receipt) <br /> A 9e� <br /> ) 3 T n S O <br /> CONTRACTOR / �U <br /> 0 <br /> m n, <br /> n o <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> � r <br /> O V <br /> SANITARY PRIVY FILLING/GRADING CAMPISUBDIVISION Z a < <br /> STRUCTURE/ADDITION USE: S/ i) ALd- <br /> (Home/Cabin; Commercial Business; Bedroom;Deck; et . ism'i,r -ee <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) 0 3 <br /> v a, <br /> T Z c <br /> 1. All required dimensions or distances to be shown or drawn to scale. m P o <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB) and indicate y' <br /> North (N). W c a <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerlinB of m ' <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. W <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildings, O <br /> roads, lake, lot lines. LJ <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 1� a <br /> signed and dated by the owner. m <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATIONEE- <br /> FORE A PERMIT CAN BE ISSUED. <br /> ii <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 <br /> ISSUANCE. Icy) <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 rHE <br /> O/F H� WAM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> /' <br /> 5. d,tj,,, * bo- No p14.0 tka^- la)f rT 'c(Q�u4) Or <br /> s. Alo � <br /> o c T N w D a <br /> mn� P' 4mM <br /> 7. p1cuos <br /> 8. O <br /> o n � i C <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the beat of my m <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and ace Aracy of <br /> all information contained In this application(including any accompanying schedule)and I further declare that I re cognize <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whett 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 Informal on I am n i <br /> providing in this application. I agree to permit county officials charged with administering county ordinances r other3 2 i <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Ins action. [ m <br /> nt <br /> SIGN HERE <br /> of neilor building co etor) - I J._ i``(date) <br /> r <br /> ZONING ADMINISTRATOR C <br /> SEP I Z I G�N N IT N N N U� m <br /> TOWNSHIP PERMITS MAY BE REQUIRED l''' 0 0 0 0 0 0 in o m <br /> ;i , � o0000000N <br />