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0/ e // l// i <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator Co _U -- 0 <br /> ili <br /> APPLICATION FOR LAND USE PERMITS d 3. <br /> z s <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 ccor- 3 <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with al other = o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. H <br /> C <br /> v <br /> OWNER L TELEPHONE ^p <br /> HOME ADDRESS 'oI <br /> EMERGENCY/FIRE NUMBER ROAD NAME ' <br /> ✓. Lei-y SrcTjet,-?b"705 e .✓S"/.,,O0..3 f/iby(�, <br /> LEGAL DESCRIPTION(see tax receipt) _ <br /> l <br /> CONTRACTOR <br /> 0 <br /> 'm O <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> N r <br /> 0 <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> J� o $ <br /> STRUCTURE/ADDITION USE: 64(e,9vv— <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 C R <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 11 <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> -n a y <br /> T o a <br /> 1. All required dimensions or distances to be shown or drawn to scale. t� <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate O1 y: <br /> North (N). w <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) buildings)to centerlins 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 buildings, > <br /> roads, lake, lot lines. O / <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. 6- <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans mus be <br /> signed and dated by the owner. Q in <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. t/ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <br /> PERMIT: q <br /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMI J <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELlh E. <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 HE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. (� <br /> 5. <br /> 6. c l� S �R-N?DSRA GcjSQ _rS 0� 000d <br /> a oc �3 W, '0 aim <br /> 7. � <br /> - Km M <br /> L.. : <br /> : `M N $ =a7 M <br /> a A O : N`Z <br /> 8. o – <br /> 62 : mi O <br /> i n i3 C <br /> m m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and aec racy of <br /> 9 P 9 P Y <br /> all information contained in this application(including any accompanying schedule)and I further declare that I reognize ' o o <br /> o , o ; <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin 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 relying on this informati n I am ; 0: 0 : <br /> P <br /> in this ap lication. I agree to permit county officials charged with administering county ordinances r other 3 <br /> authorized perso o ave access to the above described premises at any reasonable time for the purpose of insp ctlon. <br /> N <br /> SIGN HERE K ZZ._f H N <br /> (signature of ner or 1 g contactor) ' (date) o <br /> \ o <br /> ZONING ADMINISTRATOR <br /> lrn <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 o fn <br /> 0 0 0000 (A <br />