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(51 <br /> BurnetKounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator c ; o o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work y "� <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- 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. H d <br /> Db(�1 LvND 612-89© <br /> OWNER TELEPHONE p m <br /> p� m <br /> HOME ADDRESS Q�Q kA�(ES-7 Coop C7.�t'��Sy �'�'rI��11 I� <br /> EMERGENCY/FIRE NUMBER 2929 1 ROAD NAME r{�p(� <br /> LEGAL DESCRIPTION(see tax receipt) r�T, LOT ' I TgoN t�P�r`�v �2r�ap�s-0(oo r <br /> �i.l <br /> CONTRACTORSHCRMA-t,A LUMW- t W4, O <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE-X ADDITION <br /> N O <br /> O <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o $ <br /> m <br /> STRUCTUREIADDITION 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 /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) p 3 <br /> -n 'R N <br /> Z c <br /> 1. All required dimensions or distances to be shown or drawn to scale. m ° a <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB) and indicate <br /> North (N). m <br /> 3. Show dimensions in feet of the fallowing: (a) building(s)to all lot lines, (b) building(s)to centerline of <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. x <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. I <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 I a <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 /> N <br /> O <br /> J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. J 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY D <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE j rl <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. V <br /> 5. <br /> f <br /> 6. <br /> M s='3 $fm <br /> �� 'am =: <br /> 7. dc0os � <br /> 8. o — m <br /> i 2)a : <br /> of C cl <br /> 8: m m , <br /> o <br /> 1 declare that this application (Including any accompanying schedule) has been examined by me and to the beat of my f y E m <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> PP (including Yaccompanying ) 9 i ora o : <br /> all Information contained In this application ineludln an schedule and I further declare that I recognize <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett retying on this Information I am o E <br /> providing in this application. I agree to peco officials charged with administering county ordinances or other- <br /> authorized <br /> ther authorized person to have access to the abo a describ4 p emises a ny reasonable time for the purpose of Inspection. ryr i <br /> SIGN HERE `r- ..� ' N'• <br /> (s ursof awne or ullding contractor) [^` date) <br /> ZONING ADMINISTRATOR . I /7�""'rclA E ((qq <br /> 21� �NNNNNNIN m <br /> O 6 6 6 0 0 N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED ,I o o b b o b o o m <br /> ' ! o0000000y <br /> I I <br /> I <br />