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Pv-�Cmp <br /> J <br /> Bumett County 74x,0 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administratorw o c <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 y <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- m ` <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other 3 <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> o <br /> OWNER �%�j1 i �V TELEPHONE�t <br /> ^ate 'G�l <br /> HOME ADDRESS2 l'A 9-7 6 C A V 67 K p Aim <br /> v Y <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CONTRACTOR <br /> 9 <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION 0 <br /> N .°r. <br /> GJi <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> Z ° <br /> STRUCTURE/ADDITION USE: I u <br /> (Home/Cabin; Com ercial Business; Bedroom;Deck;etc.) (21 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR L. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> O Di <br /> X 9) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O B <br /> m p rn <br /> Z! ZS <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). <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. Z <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. 01 J <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- ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> N <br /> O <br /> 7 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> N <br /> A <br /> n <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY v <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 /> 6. <br /> rn rnvrnr D Dv � <br /> o.c M.w m F <br /> 8. o ma: �'Cn o <br /> N : n A <br /> 1 declare that this application (Including any accompanying schedule) has been examined by me and to the best of my ` G) p <br /> m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize 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- S o : 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 0 0 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 E 2 : <br /> authorized person to have access to the bove described premises at any reasonable time for the purpose of inspection. T i ? m m <br /> SIGN HERE <br /> FAi <br /> (signature of owner or building contractor) (date) o <br /> �� I I�j o i <br /> ZONING ADMINISTRATOR �JI(,a G IL� 2b1 <br /> vi vivi�viviF»fn �1 <br /> s NN N N N N f 71 m <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0000000 0 00000 o m <br /> 0 <br /> 00000000N <br />