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&A eorYt <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator d - 0 O <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for th D work y <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- q o. (� <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with a I other 3. o 1 <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. N d <br /> OWNER ,- (J ,/ ( 114 ?7j� <br /> h A)//L.TOZ/TELEPHONE <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) f// y y S 1! -39 -14 <br /> CONTRACTOR <br /> n p <br /> TYPE OF PERMIT(S): DWELLING/BUILDING - GARAGE/ACCESSORY STRUCTURE4k ADDITION 0 <br /> N <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> - <br /> Z 'O <br /> G P m <br /> STRUCTURE/ADDITION USE: ` / <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> r <br /> o_ <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> a <br /> m 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). y <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) building(s) to centerline of m <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. SIJ a <br /> 4. Show the location of the well (W), septic tank (ST) and drainfield (DF), and all distances to buildings, I <br /> roads, lake, lot lines. <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 Ca <br /> signed and dated by the owner. � <br /> 011 g <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION E- � a <br /> FORE A PERMIT CAN BE ISSUED. <br /> 2. <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 PERMI <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELI JE. <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 rHE (� <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> 6. <br /> rnrnvvi DDF y <br /> 7. m R' 'Ramg „ m <br /> o 0 < : m o <br /> .� < W : `� N O +O <br /> w f0 O Z '� <br /> 8. Oy <br /> £ T . M <br /> ,V�i L7 c 0 <br /> 0 <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the beat of my M��; m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and ace iracy of <br /> all information contained in this application(including an accompanyingschedule and I further declare that I re ci nize �f. v . o o <br /> PP (' 9 Y 1 9 op ? <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 informat on I am c� p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances r other 3 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Insl iection. T m <br /> / <br /> SIGN HERE 9 7 <br /> N ; <br /> (a nature o r or building contractor) (date) o <br /> o <br /> ZONING ADMINISTRATO <br /> n <br /> N N N N N N m <br /> TOW IP PERMITS MAY BE REQUIREDo c u o N p o m <br /> 0000 ' o00 <br /> 0000 000 (A <br />