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W-Y/ <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m -0CD o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work H <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- ` <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. <br /> OWNER "(� \\ ' TELEPHONE ,1 <br /> m <br /> HOME ADDRESS � \�� ��l 5190] = <br /> d N l <br /> EMERGENCY/FIRE NUMBER Q�.,O��� ROAD NAME ([J <br /> LEGAL DESCRIPTION(see taxreceipt) <br /> CONTRACTOR <br /> I 1 <br /> ,1— o <br /> n p <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTUREADDITION 0 <br /> N O <br /> O <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION c a <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; ComrWercial Business; Bedroom; Deck;etc.) <br /> o _ <br /> e <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> -n P m <br /> 1. All required dimensions or distances to be shown or drawn to scale. n o a <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB) and indicate m y' <br /> North (N). y ° <br /> 3. Show dimensions in feet of the following: m <br /> (a) building(s)ng(s) to all lot lines, (b) building(s)to centerline of <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. r <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildings, I n / /� <br /> roads, lake, lot lines. 1 l/� <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. 1 <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 BE- <br /> FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. U1 <br /> CONDITIONS OF PERMIT: o <br /> N / 11 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT if <br /> ISSUANCE. IL—Q <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 D <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> f <br /> 6. <br /> co Co vrnrDO 'y <br /> C <br /> w <br /> M <br /> In <br /> o ` C <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 <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize o o <br /> that this Information I 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 O p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ? 3 ? 8 [ <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. <br /> N <br /> SIGN HERE � <br /> � ) N ; <br /> signs t"ihororb Irlcontractor) (date) <br /> f"Pr1 : o E E <br /> ZONING ADMINISTR 161211 ° o <br /> n <br /> N N r T N N N N <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 m <br /> 0 o m <br /> 0000gogofl� <br />