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6�1 e <br /> Burnait County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR LAND USE PERMITS d 3_ <br /> z s <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 inaccor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other 3 V <br /> 0 <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> OWNERTELEPHONE <br /> -771 �f/' 71 Ser 7L _ / <br /> HOME ADDRESS // �/ S a/ �a `'r I•-t"1— () <br /> EMERGENCY/FIRE NUMBERI / ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CONTRACTORI o <br /> 04. o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE_ � ADDITION 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> 0 0 <br /> STRUCTURE/ADDITION USE: r'e <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 CR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. nl <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) p 3 <br /> m a V) <br /> T o a <br /> 1. All required dimensions or distances to be shown or drawn to scale. n <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB) and indicate m y' <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 riv r. <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. ''+1 <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 musl be r <br /> signed and dated by the owner. w co <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ? fyfyfyjjj,,,�lif <br /> CONDITIONS OF PERMIT: o <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 9 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE <br /> 5 OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> f <br /> 6. <br /> oc� Niu � D 017 <br /> 7. mem —iii �� cm �� M <br /> Cy 0 3 C <br /> D tD O 0 0 ?Q <br /> N <br /> Z f T1 31 <br /> 8. m <br /> v L O <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the bes of my G) <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of g'„ m d : p <br /> m vt <br /> all information contained in this application(including any accompanying schedule)and I further declare that Ireognize [ o o <br /> o , o : <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 O p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances c r other 3 2 <br /> authorized pars have access to the above describe remises at any reasonable time for the purpose of insp ction. <br /> m N <br /> r m i <br /> SIGN HEPill <br /> nature of owneror ullAing contrac r) (date) J-! o <br /> o ; <br /> ZONING A MINISTRATOR i <br /> vi vi�v3`n F»� M <br /> N N U t N N N (N m <br /> TOWNSHI MITS MAY BE REQUIRED o n u o u u v o m <br /> 00000000 <br /> 0 0 0 0 0 0 0 o N <br />