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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator f <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work v C <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor-IM <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. C <br /> OWNER -� TELEPHONE((,,) �( v <br /> / m <br /> HOMEADDRESS�� X r ?13 mom <br /> TELEPHONE( <br /> om A, <br /> EMERGENCY/FIRE NUMBER ROAD NAME,i �5CVnt <br /> LEGAL DESCRIPTION(see tax receipt) 999��, t�alo'111, D 7T <br /> � D/ pAy <br /> D cl c� (1 l <br /> CONTRACTOR Sia 1`�• k(���5 v �� <br /> CD L7 <br /> TYPE OF PERMIT(S): DWELLING/BUILDINGXGARAGE/ACCESSORY STRUCTURE ADDITION 0 <br /> H O <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> z <br /> I 'l o M <br /> STRUCTURE/ADDITION USE: �/ I � <br /> (Home/Cabin;Commercial B iness; B droom;Deck;etc.) r <br /> f� o <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) O 3 <br /> cn <br /> T Z C <br /> 1. All required dimensions or distances to be shown or drawn to scale. FL <br /> m y. <br /> 2 .Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate L <br /> North (N). y <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline 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. <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. C <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be 3 <br /> signed and dated by the owner. < Cn <br /> e 0 <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. a <br /> CONDITIONS OF PERMIT: -� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 60 <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 /> 6. <br /> (n co-0(nr D m <br /> Z £ O T Cn <br /> 8. c �i ; a ? C <br /> 5Q ! E <br /> o <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> o� o <br /> all information contained In this application(including any accompanying schedule)and I further declare that 1 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- o , O , <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am n: 0 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 ' <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. T CD <br /> a y <br /> SIGN HERE <br /> (signature of owner or building contractor) �' - '=—(d=e) '• ': o <br /> ZONING ADMINISTRATORJun 2 "'^" i40 <br /> i NN (TNN NtT m <br /> O (TNONNfTO <br /> TOWNSHIP PERMITS MAY BE REQUIRE j _ )A 0000 o g 06 m <br /> _ 00000 00 to <br />