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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Admini trator m/ t o <br /> APPLICATION FOR LAND USE PERMITS '- 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work 57 <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 a I other 3 <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. H m <br /> OWNER /' FO <br /> JC7V1/,, n If � VeP- TELEPHON (PIZ (O „ `, p m <br /> HOME ADDRESS 112– <br /> EMERGENCY/FIRE <br /> IZEMERGENCY/FIRE NUMBER ROAD NAME old <br /> J /11 <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CONTRACTOR /fl r" <br /> o <br /> VV m 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> r 7 o <br /> SANITARY—,K--PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION '. <br /> II o ° <br /> STRUCTURE/ADDITION USE: Q Oew� r\ SU <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) t p <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE C R <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) A o <br /> O 3 <br /> T P rn <br /> 1. All required dimensions or distances to be shown or drawn to scale. n o <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate m (� <br /> North (N). L. <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) building(s)to centerlin of m �N o <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 /> roads, lake, lot lines. <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. 0 �1 <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. w <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION B - c <br /> FORE A PERMIT CAN BE ISSUED. Fa <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. I� <br /> CONDITIONS OF PERMIT: <br /> o J <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) ) Z <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OFT E I\ <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> 6. <br /> mmvn aao <br /> 7. x °. a �n of m <br /> nl f�D y. : `z N o J � 3 <br /> E o <br /> N <br /> 8. <br /> Ni c2i m <br /> m m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best f my ' GI <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of ? -, N p <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize E om o <br /> 000 ; <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- o : o <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this informatior I am O p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to access to the b ve described premises at any reasonable time for the purpose of inspe tion. H I <br /> v N j N <br /> SIGN HERE <br /> i <br /> (signature of owneroIlAlna contractor) (date) <br /> ZONING AQaNISTRATO <br /> i $ <br /> i <br /> L N N f I N N N°t m <br /> TOWNSHIP PERMITS MAY BE REQUIREDo m v, o u, P u o <br /> G <br /> m <br /> $ $ $ ogSoui <br />