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(91) 0& qj <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office,of Zoning Administrator d � 0 0 <br /> APPLICATION FOR LAND USE PERMITS d 3. _ <br /> z s c� <br /> TO T"IE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work V N <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- fD <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other 3 <br /> 0 <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y m <br /> V F <br /> TELEPHONE <br /> HOME ADDRESS 3 ` , fG„ M ^ <br /> I <br /> EMERGENCY/FIRE NUMBER ROADNAME <br /> 1 <br /> FF- <br /> LEGAL DESCRIPTION (see tax receipt) S <br /> CONTRACTOR C r <br /> c <br /> 0 <br /> m c� <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION 0 »' <br /> 0 <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION--)L <br /> 1 // �rr�� 0 <br /> STRUCTURE/ADDITION USE: 0.� , v , ) <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;at,:.) <br /> r <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. NY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m Q <br /> O CDIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> a y <br /> 1. All required dimensions or distances to be shown or drawn to scale. n <br /> o or <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings (NB)and indicate In N' <br /> North <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) buildini to centerline of m c-C <br /> road, (c) building(s) measurement to the ordinary high water mark (OHWM of lake, stream or river. S 9) �n <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildings, C' <br /> roads, lake, lot lines. <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. SO P <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be F- <br /> signed and dated by the owner. G (n <br /> CJ � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- a <br /> v = <br /> FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 130 DAYS OF PERMIT <br /> ISSUANCE. 0 <br /> REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 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 PERMITTE Imo\} <br /> 6 3 l.-l `-� <br /> 6 moo 's £pp£ <br /> In <br /> 7 �j � c�2 /'2r•-o f A. <br /> o : <br /> mo <br /> = f _ u,i <br /> e. o — <br /> ` A <br /> o nom : C <br /> I declare that this application (including any accompanying schedule) has been examin d by me and to the best of my m : m <br /> knowledge and belief It is true, correct and complete. I acknowledge that I am responsib for the detail and accuracy ofrrw <br /> vg„'ig T O <br /> PP (including Yaccompanying 1 90 m o <br /> all information contained in this application Ineludin an schedule and 1 further declare that I recognizeo !° o <br /> that this information I am providing will be relied upon by the County of Burnett Wiscons n in determining whether to is- <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett elying on this Information I am O p <br /> providing in this application. I agree to permit county officials charged with administer ng county ordinances or other : 3 : i4 <br /> authorized person to have access to the above described premises at any reasonable tim i for the purpose of Inspection. ppm ! i i <br /> la N <br /> H i <br /> SIGN HERE f^ <br /> N ; <br /> (si of owner or bui ding contractor) (date) <br /> Yk o : <br /> ZONING ADMINISTRATOR <br /> ._ e3�j'F»vi ei j' 71 <br /> TOWNSHIP PERMITS MAY BE REQUIRED m <br /> o Inu� o �nu' Ino m <br /> 00000000 <br /> 00000000N <br />