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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m ; o <br /> APPLICATION FOR LAND USE PERMITS w 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work <br /> described and located as shown herein. The undersigned agrees that all work shall be done in ccor- q ` <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 /> OWNERv U(44 <br /> h TELEPHONE ^p m <br /> HOME ADDRESS <br /> � 1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) / /� c/ <br /> CONTRACTOR L�2 �j(4vy I'© V . --ITle-If - 't/I T 3 v. <br /> L) <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE—X-=ADDITION 0 <br /> N Q <br /> O ` <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> — <br /> Z ° <br /> STRUCTURE/ADDITION USE: cj ! <br /> (Home/Cabi ommercial Business; Bedroo ; 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. In <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> -n 3 <br /> 'n P a <br /> T Z <br /> 1. All required dimensions or distances to be shown or drawn to scale. l <br /> 2. Show the location and size of all existing buildings(EB) and all new buildings(NB) and indicate mrQ N <br /> North (N). in l <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of m Uli <br /> v,{ <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 buildir gs, <br /> roads, lake, lot lines. <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 a ' I <br /> signed and dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION B - <br /> FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. / <br /> CONDITIONS OF PERMIT: 4 <br /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMI <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 ? <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF 1 HE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> 6. <br /> rnmv(nr > DO 17 <br /> T. <br /> m <br /> m m <: <br /> '?! FW <br /> Z F ° Trn ; M <br /> rn <br /> 8. o — <br /> ID <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the bes of my X;r <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accu cy of p <br /> all information contained in this application(including any accompanying schedule)and I further declare that I rat Dgnize o o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining wheth4 r to Is- <br /> o : o : <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 i O E o <br /> providing in this application. I agree to er county officials charged with administering county ordinances o other 3 <br /> authorized pars have cess tot o described premises at any reasonable time for the purpose of insp ction. m i m <br /> 2 W : <br /> � H <br /> SIGN HERE N <br /> (signature o owner or building contractor) (date) [ o E <br /> 1 1 <br /> ZONING ADMINISTRATOR I: o <br /> Fn wF» e3 F»ta� -n <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N u, N P N u, m <br /> O ro fa O U t)t V O <br /> 0 0 0 0 0 0 0 0 <br /> 00000000 (n <br />