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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator N -'U 0 o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> z s <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work t <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 /> 0 <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> OWNERTELEPHONE G <br /> )�aori9ri os s <br /> HOME ADDRESS //91 l Art /11 LiNe /a45 Alug 5, <br /> EMERGENCY/FIRE NUMBER J`)e 73 j ROAD NAME /� ,i `J/�� �• <br /> f (�QAAUUU���✓✓✓!!! <br /> LEGAL DESCRIPTION(see tax receipt) e- WA-1 <br /> CONTRACTOR <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE_ —ADDITION <br /> N Q <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a <br /> o v <br /> STRUCTURE/ADDITION USE: <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 OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 <br /> m P N <br /> m o <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 N <br /> North (N). C ' Z <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. 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. I l 1 <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be 4 K <br /> signed and dated by the owner. co <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. <br /> o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: o <br /> 3. <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 9 <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 /> NNv �� $<ym <br /> 7. g �;�� ay - ° M <br /> z . iu� No ; ; <br /> O O K <br /> -j f <br /> 6. m <br /> �I <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ` m m <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuO <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 o E <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other <br /> 3i x , <br /> authorized person to have access to the aba described premises at any reasonable time for the purpose of Inspection. <br /> SIGN HERE <br /> e of owner or I g contractor) ` l --- I j �I, <br /> 20NING INISTRATOR <br /> -n <br /> � t11ocNi+ INi, orNiiN VNiom <br /> TOWNSHIP PERMITS MAY BE REQUIRED i o 0 o c o 0 0 0 <br /> M <br /> I „j �---- 00000000fA <br />