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Mi l e <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator (n _0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <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 accor. 3 a <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. O <br /> In <br /> OWNER TELEPHONE ^p <br /> (j <br /> HOME ADDRESS /�' 1 6 _ r� S� �' i N� S <br /> EMERGENCY/FIRE NUMBER s 7 Q ROAD NAME C e' <br /> LEGAL DESCRIPTION(see tax receipt) •rl <br /> CONTRACTOR -S,-/K /e e I r C x C pir/S- O <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE—ADDITION-25:_ � � G <br /> O <br /> » <br /> - <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a <br /> 1 o a° <br /> STRUCTURE/ADDITION USE: WD �/1 a cp/ <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 C R <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. �I <br /> O <br /> A S) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 <br /> T P Cn <br /> T Z v <br /> 1. All required dimensions or distances to be shown or drawn to scale. m o n <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB) and indicate 0 N <br /> North (N). m <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerlineof r., <br /> road, (c) building(s) measurement to the ordinary high water mark (OHWM) of lake, stream or river. IV <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 mus be <br /> signed and dated by the owner. in <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION E- ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> 2.0DC <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <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 I n <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE I� <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> � p f <br /> 6. -SC <br /> rnmvvi > > y <br /> oc � mlv <br /> tom <br /> 7. m ms = � <br /> wc , 0 ' 3 <br /> 1n <br /> Z £ rNE <br /> 8. ` N i c 2 Mm <br /> o ate : C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the bet of my m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and acet racy of u, O <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize —: <br /> o . <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining wheth r to is <br /> a permit. I further accept all liability which may be a result of the County of Burnett relying on this Informati n I am O o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances 4 r other 3 <br /> authorized person to have access to a above described premises at any reasonable time for the purpose of insF action. <br /> � m <br /> SIGN HERE <br /> (signature of owner oruil It cony ) (date) o <br /> ZONING ADMINISTRATOR <br /> e>tn�F»Enw� n <br /> N N f I f N N N N m <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 o mo D o m <br /> 0 0 0 6 6 0 0 N <br />