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6 l / <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ( 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 m <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- y <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other J <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y l <br /> OWNERzes QI¢ TELEPHONE <br /> HOME ADDRESS aOs���At/WO � //•/l� ,LG[!/S/UJ� �7 O �S�^-� (� <br /> EMERGENCY/FIRE NUMBER <br /> ROAD NAME a// <br /> L./` C p I <br /> LEGAL DESCRIPTION(see tax receipt),V7— GnY- C5/yr✓ZTGS <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE. <br /> o <br /> IL_ADDITION o <br /> N O v 1 <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION v <br /> STRUCTURE/ADDITION USE: fid <br /> `"I�(/'�(� <br /> (Home/Cabin;Commercial Business; Bedr am;Deck;etc.) <br /> r <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR o <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> O IIVIll <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 <br /> a Cn <br /> 1. All required dimensions or distances to be shown or drawn to scale. � o g <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 I <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, S1J <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 00 <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 /> o <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 I�1 <br /> ISSUANCE. N <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. a <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 /> vi rn v $ v <br /> 7. s ° r < U)li� = f m <br /> s arcam ,-; � <br /> A N N. : 'z N p =Q i <br /> 9 <br /> m <br /> ate : C <br /> m m <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 �(m N: O <br /> that this Information I am providing will be relied upon by the County of Burneall information contained in this application(including any accompanying schedule)and I further declare that I recognize o o <br /> E 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 tt Wisconsin In determining whether to is- <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other n 2 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. m E <br /> SIGN HERE LQ �, ^ _'�.' f _q <br /> (sl re of ar or b i contractor) <br /> ZONING ADMINISTRATOR (' S <br /> t , <br /> 'ISI ' ) v�inww�e�i»`fT <br /> TOWNSHIP PERMITS MAY BE REQUIRED �i'`l1 0 0 0 0 0 0 o m <br /> � 0000000l�l1 <br />