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A c <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator E ; o 0 <br /> APPLICATION FOR LAND USE PERMITS d 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work y g <br /> described and located as shown herein. The undersigned agrees that all work shall be done in ccor- 3 n <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> Paklsen <br /> OWNER ti��. �S TELEPHONE ,_ —�1 I1 • / 1- v <br /> HOME ADDRESS 7� J 1 Wp I�-� er \n -r b <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION <br /> o <br /> SANITARY PRIW FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> 1 / Q o a° <br /> STRUCTURE/ADDITION USE: V . + (J W <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. r <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> -n 3 <br /> T P m <br /> 1. All required dimensions or distances to be shown or drawn to scale. 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: (a) building(s) to all lot lines, (b) building(s)to centerline of m <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 buildin s, <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. ( y <br /> 2 <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: o <br /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT s <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. ) wn <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OFT E <br /> 5 OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. Uj <br /> f <br /> 6. <br /> (n(nv (nr D DO 'y <br /> m o. c a m '^ M <br /> 9 R O <br /> 8. <br /> o — m <br /> RE : ' C <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 accuracy of N m p <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o o <br /> 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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 x <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. m m <br /> m : <br /> SIGN HERE " N <br /> (signature of owner or building contractor) (date) 0 <br /> —jim-f� : o : <br /> O ; <br /> ZONING ADMINISTRATOR <br /> t»vi j'Fn Fn F»� m <br /> NN N N N N N m <br /> TOWNSHIP PERMITS MAY BE REQUIRED o u+ N o u, un v o m <br /> 0000 o 0o0N <br />