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ezw o, <br /> Burnett-Cotinty 7410 Co. Rd. K, No. 102, Siren,WE 54872 Office of Zoning Administrator t -U0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for thi work � � d <br /> described and located as shown herein. The undersigned agrees that all work shall be done in i ecor- '3 <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other - o ,jJ <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. H m <br /> OWNER I O d ] w • P� r(�C TELEPHONE (blZ.) 686-7?97 p y <br /> HOME ADDRESS 610 W. nAK-LE av,' P/ ,JD�q �/P� � ,T ? � � CD <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> r <br /> LEGAL DESCRIPTION(see tax receipt) (-, l- L S•M y '3 r I I /cy <br /> h p J L-o .� <br /> CONTRACTOR 3Q.�� Qkv r A162a'i [/ T�. f 0A <br /> 2 o rn <br /> TYPE OF PERMIT(S): DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ADDITION 0 <br /> m O <br /> O <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION <br /> 0 0 <br /> a <br /> m <br /> STRUCTURE/ADDITION USE: <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 O <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) A <br /> O 3 <br /> n a y <br /> 1. All required dimensions or distances to be shown or drawn to scale. n o n <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB) and indicate m y: <br /> North (N). C °, <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s) to centerline of m 1 <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. <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 /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION B - °_ <br /> FORE A PERMIT CAN BE ISSUED. <br /> N <br /> O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 2' <br /> CONDITIONS OF PERMIT: o <br /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT s (l J <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. D <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OFT E <br /> OHWM O,nnF� LAKE,S,PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. -�56N l—I r lF-y )9EZ ()l 1 1� lq&53 <br /> 6. 1 l <br /> �() �O �S - S.t� jliS cIC1 ' � �Ueps '&1 <br /> m m r <br /> �3 ?` r,`• Ci t1WM. ��� ON� ' SQ�..S� 7 1/`A-tt ,, -o rn D 1 <br /> 7. J � �el 11\c p oaG0nm - <br /> 6. 4)D <br /> 5 2C �Ej , A <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best f my <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accur, cy of E N yam„ , p <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o o <br /> oo : <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether .to is- I o : o <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 ; O p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ` N i4 <br /> authorized person to have accessto the above described premises at any reasonable time for the purpose of Inspection. T ? ' v H E <br /> SIGN HERE / . /U. /I d'th ���'''�- .../�� <br /> (signature of owner or builtli c ntractr �(5tlafta-)o . v' <br /> Ei oZONING ADMINISTRATOR OCT I975 <br /> rooo <br /> i <br /> E i <br /> TOWNSHIP PERMITS MAYBE REQUIRED p p, u, o p, P . o <br /> $ 0 0 0 0 0 o N <br /> ULLV Sink ID -�3 Lf5— <br />