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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administ ator m 0 0 <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 <br /> described and located as shown herein. The undersigned agrees that all work shall be done inIcor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with allother o t( <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> OWNER �.� �� TELEPHONE 'p m <br /> m <br /> m <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER I� ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) N'C —S — y — v l <br /> CONTRACTOR C _ p -- <br /> m G) <br /> a. < <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION 0 <br /> N <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: `—SII I V- I r C/ <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 O <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n <br /> O <br /> ;a p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> Z c <br /> 1. All required dimensions or distances to be shown or drawn to scale. In <br /> o a <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB) and indicatey <br /> North (N). to <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of In 'I <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. !� r <br /> 4. Show the location of the well (W), septic tank (ST) and drainfield (DF), and all distances to buildi gs, 9 <br /> roads, lake, lot lines. C) <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 musl be 17 <br /> signed and dated by the owner. co <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION B - <br /> FORE A PERMIT CAN BE ISSUED. ) ' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> N <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 D <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 /> o c - N D D 17 <br /> In <br /> 7. 3l a'� dny $ � M <br /> al N <br /> K. C N j 7X <br /> J <br /> 9 A O ? 0 o <br /> Z Fo Tu,: >7 <br /> S. P . N: 32— i m <br /> O : OC (_ <br /> N N <br /> 1 declare that this application (Including any accompanying schedule) has been examined by me and to the bes of my y: ; m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of _ [ N m it'n : O <br /> PP (including Yaccompanying Irecognizeoio o : <br /> all information contained in this application Includin an schedule and I further declare that I O o m o <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining wheth r to is. o : o : <br /> F: <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 n o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances r other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of insp action. ,n <br /> SIGN HERE <br /> N : <br /> (signature of owner or building contractor) (date) o <br /> ZONING ADMINISTRATOR �✓1. <br /> •n•n�t»•n•n�' n <br /> N Ntn NNNtn rn <br /> PUn N <br /> O . . O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o ac 0 0 o m <br /> 00000000fA <br />