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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Adminislirator w m 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 0 <br /> described and located as shown herein. The undersigned agrees that all work shall be done in Icor- 3 n <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. 0 m <br /> OWNERTELEPHONE ^a"1 _ /' p 0 <br /> ti m �7 <br /> m _ <br /> HOME ADDRESS j <br /> EMERGENCY/FIRE NUMBER ROAD NAMEIL <br /> LEGAL DESCRIPTION(see tax receipt) U I <br /> CONTRACTOR V/7�L� o X <br /> 'm L7 <br /> n 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> N <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> / p <br /> STRUCTURE/ADDITION USE: ,7V 4 �C� <br /> �1 <br /> (Home/Cabin; Commercial Business; Bedroom;Deck; etc.) <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) p 3 <br /> n' rn <br /> 1. All required dimensions or distances to be shown or drawn to scale. m o a <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings (NB)and indicate <br /> North (N). <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 buildings, <br /> LA <br /> roads, lake, lot lines. t Q <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 I r <br /> signed and dated by the owner. r <br /> 0 i) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION E E- <br /> FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: I� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF FERMI <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELI JE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �"JN <br /> ? <br /> PERMITTED. I K 9 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF HE Q <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. \j <br /> 5. <br /> 6. <br /> Cn <br /> < y: zyo =� 3 <br /> B. � a o <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the be t of my O E m <br /> �d �: <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and ace racy of v' m o, , D <br /> oo o : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I cognize <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whet er to Is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Inform at on lam ? n o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances 3r other ' <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of ins oection. m �^ <br /> � N <br /> SIGN HERE `&4 -2? H N <br /> (a na reof own Ildln contractor) (date) <br /> o : <br /> ZONING ADMINISTRATOR i i {/'y;,. <br /> » E» n <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 ' o S <br />