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on <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator d - -0 0 <br /> APPLICATION FOR LAND USE PERMITS d 3_ _ <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work y <br /> described and located as shown herein. The undersigned agrees that all work shall be done in ccor- = a d <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other 3 <br /> d <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y <br /> OWNER (�(f t j �/fs (,(,)�j i �t J TELEPHONE 6/.7 - 7 Jr7- 5'J0' ^p v 0 <br /> 4 m _ <br /> HOME ADDRESS 2� et <br /> EMERGENCY/FIRE NUMBER 3 / I� ��: �1/,-ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt)�n�6G 15�O <br /> CONTRACTOR De4IZE lg:;"- <br /> m O <br /> n 2 <br /> TYPE OF PERMITS): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION <br /> r <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o v / <br /> STRUCTURE/ADDITION USE: 1 /C /C�� �/ f//f a�D� 4— Iv\`II <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) �{n <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE R <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) p 3 <br /> T P y <br /> T o a <br /> 1. All required dimensions or distances to be shown or drawn to scale. m <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB) and indicate N <br /> North (N). m <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerlineof <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. I <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be 0 r <br /> rF, signed and dated by the owner. m <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION E- ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMI <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 <br /> PERMITTED. <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 /> F <br /> 6. <br /> nimVmr y <br /> 7. m � �`� Ram °' y <br /> m <br /> A l�D y `Z N O J 3 <br /> L' ((�� y�,I f 3 21 N <br /> c��, O <br /> � i m m C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the be t of my m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and ace racy of o o O <br /> all information contained in this application(Including any accompanying schedule)and I further declare that I re ognize . b E o <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining wheth r 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 ti n I am O[ <br /> providing in this application. I agree to permit county officials charged with administering county ordinances r oth 3 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Ins ction. r ; ; ? y <br /> v <br /> SIGN HERE H <br /> (ai a of owner Ilding contractor) (date) o <br /> of <br /> o i i <br /> ZONING ADMINISTRATOR <br /> 91 5 N N O N N ro (1� m <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 0 0 m <br /> g o00000o f/1 <br />