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0�Cc« 3L/q- 0 13 S' <br /> Burp&tt County 7410 Co. Rd.K, No. 102,Siren,WI'54872 Office of Zoning Administrator <br /> W m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes applicati n for a Permit for the work <br /> a o — <br /> described and located as shown herein. The undersigned agrees that all w rk shall be done in actor <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanita on Code,and with all other - o <br /> applicable County Ordinances and the laws and regulations of the State of Wi consin. H m <br /> rf)rs Aruold <br /> OWNER TELEPHONE <br /> y ' z <br /> HOME ADDRESS LL\ C-1•J <br /> J i � <br /> EMERGENCY/FIRE NUMBER ROAD NAME D .Y'I SK <br /> J I 1 <br /> LEGAL DESCRIPTION(see tax receipt) <br /> W. <br /> z-' <br /> CONTRACTOR `ccs. �J(' ` _ C\ <br /> � T V?f 0 <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION 0 »- <br /> N O <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION v <br /> pT1 ' Z o <br /> STRUCTURE/ADDITION USE:VCO'(�L\a ����"`i VV �� ` ' ^OV`C� cT <br /> (Home/Cabin'Commercial Business;Bedroom;Deck;eti.) <br /> a <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) O 3 <br /> n a N <br /> 1. All required dimensions or distances to be shown or drawn to scale. o n <br /> 2. Show the location and size of all existing buildings(EB)and all new buildings (NB)and indicate m UJ N: <br /> North (N). w r- <br /> ° <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) bilding(s)to centerline of m .9 <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 II distances to buildings, <br /> roads, lake, lot lines. <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or 0Iled. <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. v <br /> ,,8 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSItE VERIFICATION BE- 0� <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. 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTEDALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESSPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTEIb. <br /> 5. <br /> f <br /> 6. <br /> mmvrnrDDp y <br /> 7. 0 '<< > > r0i nom <br /> 'Zmo �n 3 <br /> _ TZ ? E 1 <br /> 8. o - <br /> y : <br /> m <br /> oi m `• —y <br /> I declare that this application (Including any accompanying schedule) has been examine I by me and to the best of my '• G) <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsiblefor the detail and accuracy of j'„ y N? p <br /> all information contained in this application(including any accompanying schedule)and 1 urther declare that 1 recognize o o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsi 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 r flying on this information I am n p <br /> providing in this application. I agree to permit county officials charged with administers g county ordinances or other 3 ; 2 <br /> authorized person to have access to the above described premises at any reasonable time..for the purpose of inspection. <br /> SIGN HERE <br /> (sig bur of owner Ing contractor) -' <br /> ZONING ADMINISTRATOR <br /> ltl NNNN NNQt T <br /> TOWNSHIP PERMITS MAY BE REQUIRE m <br /> 1.� U --- $ 0000000N <br />