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Burnett County,7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator cn m -00 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work o� y - <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. y m <br /> OWNER iq,�tf et �I <br /> 6.Ct TELEPHONEQhr - I1 S o <br /> HOME ADDRESS P <br /> 0, <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CONTRACTOR PAe �S CJttilc�p� C l,(p� EOtIH� hl lam. Qclt+ -1 U,1 S�(c� q R <br /> TYPE OF PERMIT(S): DWELLING/BUILDING�_ oGARAGE/ACCESSORY STRUCTURE ADDITION � .��- <br /> 0 0 <br /> SANITARY-7Y.PRIW FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: 1401vt� wJ/A AaaLi 194v' 1 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) CA <br /> r <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 /> -n 3 <br /> -t 9 m <br /> 1. All required dimensions or distances to be shown or drawn to scale. 0 o S <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB)and indicate In <br /> North (N). w `- <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. 01 <br /> 4. Show the location of the well (W), septic tank (ST)and drainfield (DF), and all distances to buildings, <br /> 1 <br /> roads, lake, lot lines. SSuu M <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 Q' <br /> signed and dated by the owner. j � <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 <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE 1` <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> F <br /> 6. <br /> mv �w� an <br /> 7. oy <br /> o. c M o m <br /> m Wg � � nm $ _ y <br /> C 2o T� <br /> 9 < o, N Z N 0 <br /> 8. Z fes : T co [ <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G): <br /> knowledge and belief it Is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of E N m N? p <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- $ f c <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett rel Ing on this Information I am O p <br /> providing In this application. I agreet permit county officials charged with administer] o or other ? 3 <br /> authorized person to ve access to above described premises at any reasonable time Ursic-0)'tisp ? ; y <br /> SIGN HERE <br /> ( n ture f ow ulltling contractor) 'tdete 1, '. o ? '. <br /> ZONING ADMINISTRATOR <br /> ( " NO "N mom <br /> m <br /> TOWNSHIP PERMITS MAY BE REQUIRED N O N N N O <br /> u, <br /> coo 0 0 0 0 0 N <br /> urx s B_1q-�,0 <br />