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N mrpv p <br /> Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator d _o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> W 3 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work y <br /> described and located as shown herein. The undersigned agrees that all work shall be done in accor- m W <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other 3 <br /> v <br /> applicable County Ordinances and <br /> the laws and regulations of the State of Wisconsin. <br /> OWNER �,j G TELEPHONE 6 . (f S/ 7 7� o m <br /> w <br /> HOME ADDRESS +� y y T <br /> EMERGENCY/FIRE NUMBER t).� ROAD NAME ��+ �� T .41 <br /> LEGAL DESCRIPTION(see tax receipt) �� 'Q OC m 15 17 as� <br /> `J �" QJ <br /> CONTRACTOR <br /> 0 o VY^I <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE-ADDITION--X, 0 �- <br /> N O <br /> O •' <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> �( o D <br /> STRUCTURE/ADDITION USE: AO <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <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) <br /> o <br /> "n v <br /> 1. All required dimensions or distances to be shown or drawn to scale. 0 o a <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings (NB)and indicate m c <br /> North (N). rn <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. I C <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. r c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- V <br /> FORE A PERMIT CAN BE ISSUED. 2. <br /> (, <br /> W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: q <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 ( Z <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE ;N <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. �J <br /> 5. <br /> 6. <br /> DDv � <br /> g.c > 0 $ m <br /> 7. m $ � 2. am » m om <br /> IC• < y: 4 ' O O fo M <br /> 8. ' ci2 m <br /> C <br /> CD <br /> 'V m ip <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G>`. ° M <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <n m fr <br /> 9 p 9 P Y u, In <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 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 p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ? 4 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. T i � ? N <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) o ; <br /> ZONING ADMINISTRATOR UatLrf) 69 1 IG�(11�a(l '• <br /> NN Cn ro fn m <br /> ra <br /> TOWNSHIP PERMITS MAY BE REQUIRED o v cn o u, to v o m <br /> 00000000V1 <br />