1996/02/14 - SANITARY - SAN - Other

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&)U 6D 71p/ Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 APPLICATION FOR LAND USE PERMITS '- 3 TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as shown herein. The undersigned agrees that all work shall be done in actor- m ` dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other 3 ?L applicable County Ordinances and the laws and regulation of the State of Wisconsin. H m Lot- 429- 58 n `dLb- 7-77 7 OWNER ni WILLA Rn TELEPHONE o HOME ADDRESS IIDL p � I_E�J V . .DO6►NzC�- gSIs�I�-r��oo�y5i VV11 t EMERGENCY/FIRE NUMBER ROAD NAME LEGAL DESCRIPTION(see tax receipt) I CONTRACTOR o 0 TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o N SANITARY_ PRIVY FILLIINNG/GRADIN"G� CAMPING UNIT SUBDIVISION Z v STRUCTURE/ADDITION USE: Rk) u (Home/Cabin;Commercial Business;Bedroom;De k;etc.) (gyp y A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) OO 3 T v cn 1. All required dimensions or distances to be shown or drawn to scale. '" o a Ll 2. Show the location and size of all existing buildings (EB) and all new buildings (NB)and indicate m y North (N). C R 1 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of m road, (c) building(s) measurement to the ordinary high water mark (OHWM)of lake, stream or river. C 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildings, roads, lake, lot lines. 5. Indicate if a walkout basement is planned and show areas to be graded or filled. 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be signed and dated by the owner. ) ( m NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- °, FORE A PERMIT CAN BE ISSUED. O THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. '- rrhee,, Inc CONDITIONS OF PERMIT: N 1 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE 5. OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. 6. 7. y 4. M :5. N. : `2 N o M U i 6. z F J T`2 : : "I L)2 In I declare that this application (including any accompanying schedule) has been examined by me and to the best of my N ` ' ei i knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m N p all information contained in this application(including any accompanying schedule)and I further declare that I recognize v! ' 0- o : that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am providing In this application. I agree to permitcounty officials charged with administering county ordinances or other � E m : authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. r 3 " 01B y SIGN HERE it �2, c�detel�~ o ZONING ADMINISTRATOR \J1 (I I of E TOWNSHIP PERMITS MAY BE REQUIREDI F9 14 +N N N m m 00 $ 0000rn