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OT- U "Y\,p <br /> Burnett Cpunty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Offic of Zoning Administrator0 0 <br /> APPLICATION FOR LAND USE PER ITS 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes applieati n for a Permit forth work <br /> z <br /> described and located as shown herein. The undersigned agrees that all rk shall be done inaccor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanit ion Code,and with all other - o <br /> applicable County Ordinances and the laws and regulations of the State of sconsin. y m <br /> o <br /> OWNER �j - TELEPHONE, m /A <br /> F <br /> c'' V 7 <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CONTRACTOR <br /> o (� <br /> o ((� <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTU E ADDITION o <br /> y r <br /> 0 <br /> 0 <br /> SANITARY PRIVY FILLING GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: ICJ <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. DtNY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T (( <br /> O W <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> T 'P n <br /> 1. All required dimensions or distances to be shown or drawn to scale. o n <br /> 2. Show the location and size of all existing buildings(EB)and all new buildin s(NB)and indicate m y: <br /> North (N). y ° <br /> 3. Show dimensions in feet of the following: a building(s) m <br /> ( ) ng(s)to all lot lines, (b) building(s)to centerlin 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, 1" <br /> roads, lake, lot lines. <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or hied. <br /> 6. If separate plans are submitted by an architect, engineer, builder, contrack Ir, etc., the plans mus be 0 <br /> signed and dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMI <br /> 4 <br /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 50 DAYS OF PERMI 0 <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELIIS E. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ? <br /> PERMITTED. :b <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF HE L <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. W <br /> 5. <br /> f <br /> 6. <br /> m(nvmr > > <br /> M 0C M< W j8 $ m <br /> 7. m <br /> MZ <br /> Z : d Coy O �: .g <br /> o ?U ; <br /> m <br /> I declare that this application (Including any accompanying schedule) has been examin d by me and to the bes of my m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responslb a for the detail and accu acy of y <br /> all information contained in this application(including an accompanyingschedule and further declare that I re o nize Cis 0 . <br /> PP ( 9 Y ) 9 m o <br /> that this information I am providing will be relied upon by the County of Burnett Wiscons n In determining wheth r to Is— <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett lying on this infonnatl n I am p <br /> providing in this application. I agree to permit county officials charged with administer ng county ordinances other 3 <br /> 3 : F <br /> authorized person to have access to the above described promises at any reasonable tim P for the purpose of insp Ction. qqT i i i <br /> SIGN HERE — LTh-<-�.;1'�-�- '-!'c.._f .�. 5- aO. N N[ <br /> (signature of owner or building contractor) (date) $ <br /> $ i <br /> ZONING ADMINISTRATOR rja <br /> R. fn fn�'fn F»fn� n <br /> NNN NNNfIi <br /> TOWNSHIP PERMITS MAY BE REQUIRED p v m m <br /> $$ S $ $ SBSfn <br />