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on / <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ,N, - o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> z s <br /> 70 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. H <br /> c m <br /> OWNER /� E� z� f J _ �k�)� C TELEPHONE ^p 1 <br /> r/ J m_ <br /> HOME ADDRESS ° <br /> �� 1 31 S74Pt r S Lq ,�C RO 'P4nJi2X'OU , cJ; SYb3C7 Cf) <br /> EMERGENCY/FIRE NUMBER ,� ) � ) ,^ ROAD NAME �-�'���5 �-qr_E 7ZI-) <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE—ADDITION 0 <br /> o = <br /> SANITARY__Y-�,_PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o ° <br /> ' ,1 �I �,y_� ,f v <br /> STRUCTURE/ADDITION USE: 1AJ�DTAtt 106 4 NU LVJ 5L T� (_- 1 ^' r-t� ? -I a` PVC ' <br /> Home/Cabin' Commercial Business; Bedroom; Deck;etc.)(JI�" oev5i&`- '6 goo S-h—� - <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR W <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In t <br /> O Jy� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O a <br /> T a N <br /> 1. All required dimensions or distances to be shown or drawn to scale. n <br /> o n <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB) and indicate m UJ o <br /> North (N). m l ' <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of <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 buildings, <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 SU <br /> signed and dated by the owner. I U) <br /> o' <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. <br /> ii <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. e <br /> CONDITIONS OF PERMIT: o <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 ? <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 y d D D7. <br /> f 17 <br /> `Z N o =rC <br /> 2 f = : �Ico <br /> 8. P =» m <br /> a , C <br /> o <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of O <br /> PP (including Yaccompanying ) g 7 ' <br /> all information contained in this application Ineludin an schedule and I further declare that I recognize o m c <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is. �� 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 o <br /> providing in this application. I agree to 3 <br /> p g pp g permit county officials charged with administering county ordinances or other 3 iQ <br /> authorized person to havccess to thea cribetl re es at any reasonable time for the purpose of Inspection. T ? m E <br /> N <br /> SIGN HERE <br /> gnature of owner or <br /> it ng contractor) (� t.(P 1 <br /> ZONING ADMINISTRATOR <br /> � AMVNO <br /> ~ N Nfli NNNN <br /> TOWNSHIP PERMITS MAY BE REQUIRED' ,! JJJ i o 0 0 0 0 0 m <br />