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6711 Cb-op <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,Wt 54872 Office of Zoning Administrator d o o <br /> APPLICATION FOR LAND USE PERMITS 3 <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 in accor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other - Sl <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. H m <br /> OWNER I TELEPHONE <br /> I V LLL777 —� t o <br /> m_ <br /> HOME ADDRESS � <br /> �,�I ► 1 l� S (lEI l/1� Ls3 �o l t �ib� o <br /> EMERGENCY/FIRE NUMBER5 ROAD NAME <br /> LEGAL DESCRIPTION(see tax�receipt) LOT <br /> Iid LJ <br /> CONTRACTOR M/// <br /> IAC-I-{1 <br /> o <br /> TYPE OF PERMUT ): DWELLINGBUILDING GARAGE/ACCESSORY STRUCTURE ADDITIONO <br /> SANITARPRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION v <br /> 1 n / o a <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Co mercial Business;Bedroom;Deck;etc.) (� <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) <br /> O 3 <br /> T P N <br /> 1. All required dimensions or distances to be shown or drawn to scale. � o <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB) and indicate m N' <br /> North (N). w <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. <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. (f" <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 /> ig <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. <br /> 0 <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 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 /> 5. OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 6. <br /> 7. M 0C '- ' DQEm <br /> A N y C o 0 5' <br /> .0i `Z N p 3 M <br /> ~ f TQ : <br /> 8. c _rn: 77 <br /> m <br /> C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ' 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 I 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- <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 <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection, <br /> m <br /> SIGN HERE ' <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> N N N N N N U <br /> TOWNSHIP PERMITS MAY BE REQUIRED o . . o v, u, u o m <br /> _iaog00000S ((a <br />