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at coy-AV <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator w � o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> iu <br /> 0 <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 actor- CD t\ <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other <br /> applicable Cou% Ordinances and the laws and regulations of the State of Wisconsin. H m <br /> CD <br /> OWNER i h v/f J 5 r TELEPHONE M(/ _ CD <br /> CD <br /> HOME ADDRESS 6 ®// &/J X5 <br /> I/�Ii✓� )4 Lt-/S yJ <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> 111 r� <br /> LEGAL DESCRIPTION(see tax receipt) a <br /> CONTRACTOR <br /> ' / o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ` GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> r <br /> W O <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION- <br /> Z <br /> h o CD <br /> $ <br /> STRUCTURE/ADDITION USE: Cj F6 <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) <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. "n <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> O 3 <br /> 21 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 In W <br /> 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. C <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. I <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 /> C <br /> CD <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. <br /> CONDITIONS OF PERMIT: o <br /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 Z <br /> PERMITTED. 9 <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 /> 6. <br /> rn V)�(Ar DDO 'O <br /> 7. M oc =. > > 8RL* m <br /> 7Dg� ay o CD M <br /> m 00 7,p <br /> �° <br /> (Do' Z =i <br /> 8. o f ' € '_' w i i M <br /> �2 m <br /> ate : C <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my m <br /> CD <br /> knowledge and belief It is true,correct and complete. 1 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 <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 n p <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T My'• <br /> SIGN HEREyrG*�/ 7� ��j ~ •' <br /> (signature of owner or bulldln contractor) (date) '�-? '• E $ <br /> �� <br /> $ <br /> - <br /> ZONING ADMINISTRATOR ; 1 I' <br /> N N N N N N to m <br /> TOWNSHIP PERMITS MAY BE REQUIRED o v v o v v v o m <br /> o$ $ $ $ $ $ $ tA <br />