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/.n"- <br /> Burnett Cgwnty 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator 'o --i Z <br /> APPLICATION FOR LAND USE PERMITS . <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- ( (D <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other 3 a Tj <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y� d <br /> lest_ N6,_ aa3 � _Z�� Z <br /> OWNER�K 1 ) ce �M.[�A TELEPHONE a- <br /> LLLL 1111 V L J� wJ /ov Y� . -IV / 0 <br /> CD <br /> HOME ADDRESS t <br /> CD <br /> 5L— C e <br /> •�f I <br /> EMERGENCY/FIRE NUMBER / q ROAD NAME e &J sAj <br /> l ©�bt. b �D UJ SlAR7d7� 1 <br /> LEGAL DESCRIPTION(see tax receipt) 3 S ws v (� t v co ) + <br /> CONTRACTOR (Wlp� <br /> JJ v <br /> TYPE OF PERMIT(S): DWELLING/BUILDING�GARAGE/ACCESSORY STRUCTURE ADDITION- 0 <br /> SANITARY PRIVY FILLING/GRADING CAM/PING UNIT SUBDIVISION <br /> - <br /> 0 Z o <br /> STRUCTURE/ADDITION USE:_ 0(Ne l IIr �O ���[ I✓ �a �/ / I <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 B <br /> m 'P in <br /> 1. All required dimensions or distances to be shown or drawn to scale. n c S �A <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB) and indicate m N: <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 9 <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. b�JO <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. I <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be <br /> signed and dated by the owner. <br /> 73 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> � o <br /> FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <br /> fA <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 0 C� <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Z <br /> PERMITTED. i 70 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE (y <br /> OHWM OF LAKES, PONDS, RIVER fUNLESS SPECIFICALLY PERMITTED. /J <br /> 5. S f'ru r-/z `-� !�d /�-o �'(vs�- '7`6 0 f�[u� -r/,,-, -rl -B-�I <br /> 6. M �%Sl� 45i/v 7- /9-5;w S 50'',Oz . <br /> .l-�qLk <br /> rn rn D D 0 <br /> °•ii = � = F m <br /> 7. y a� qro•o (D <br /> 8. o =W i i 70 <br /> M <br /> O <D Z <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ; m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ,, m p <br /> all information contained in this application(Including any accompanying schedule)and I further declare that I recognize o a o: <br /> that this information 1 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 relying on this Information I am p <br /> providing In this application. I agree t ermit county officials charged with administering county ordinances or other <br /> P 9 PP 9 9 tY 3 <br /> authorized ve access t e ve described premises at any reasonable time for the purpose of Inspection. m U : <br /> � : <br /> N <br /> SIGN HERE �� N <br /> (signs o owner or building co ctor) <br /> ZONING ADMINISTRATOR i o <br /> vi io:o �T q -.a -n <br /> N N I n N N ra (J t m <br /> TOWNSHIP PERMITS MAY BE REQUIRE 0 0 0 0 0 0 o m <br /> .a l.: o0000000N <br />