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Burnett County 7410-Co. Rd: K, No. 102, Siren,WI 54872 Office of Zoning Administrator (u - 3 0 <br /> APPLICATION FOR LAND USE PERMITS w 3_ <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- 3 <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. <br /> n <br /> OWNE TELEPHONE )U p m <br /> � -7)U <br /> OS71 i <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER ,I1,1 -- ROAD NAME <br /> LEGAL DESCRIPTION (see lax receipt) —�U <br /> CONTRACTOR1-----==y'IT <br /> TYPE OF PERMIT(S): DWELLING/BUILDING�GARAGE/ACCESSORY STRUCTURE ADDITIO 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ~nn <br /> a <br /> STRUCTURE/ADDITION USE: ' �/ W <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <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. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O In a y <br /> n z T <br /> 1. All required dimensions or distances to be shown or drawn to scale. m P a <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB) and indicate C o <br /> North (N). m <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of m 9J <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. Cj <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildings, lf) <br /> E <br /> roads, lake, lot lines. 0 <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 <br /> signed and dated by the owner. ,.. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- U� <br /> FORE A PERMIT CAN BE ISSUED. <br /> oS. <br /> W <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 PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 70 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 9 <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. J_[l <br /> 5. <br /> 6. Ste. Variance <br /> em o c to 00 a F m <br /> 7. <br /> m ' am a� M <br /> Co <br /> Z F Cn 1 <br /> o M <br /> 8. �[ �� A <br /> o y <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of my ' 0 [ <br /> PP 1 9 Y ) Y d y, G <br /> knowledge and belief it Is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of <br /> om o : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 6f0 0 <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 0 : 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 v <br /> 3 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 <br /> authorized person!P tr ( act ss to the above described premises starry reasonable time for the purpose of inspection. rym , i !� <br /> SIGN HERE G' <br /> Agnealre ofowAror building contractor) (date) <br /> e <br /> ZONING ADMINISTRATO( <br /> i <br /> N N u N" N NnmN m <br /> O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o f n N N U p O t o o a 0 o m <br /> 0 0 0 0 0 0 o N <br />