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cvynp <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator m m o a <br /> APPLICATION FOR LAND USE PERMITS w 3. <br /> 70 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 actor- `= <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. y m <br /> OWNER�j�' Ml.-,IIAIAGTj TELEPHONE 7/S d sd <br /> � D <br /> HOME ADDRESS -3630-1 5F.I.,A.IA LEp <br /> A �O� � h(,{(v V V 1 ��9-� <br /> t !-I w U <br /> EMERGENCY/FIRE NUMBER ,�'] ,---- ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt), <br /> CONTRACTOR ('t`a�'T�IZ gUaGOi�6S <br /> 0 <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION <br /> r <br /> y O <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> z a <br /> O_ . o <br /> STRUCTURE/ADDITION USE: MSM-. r'/�gaec /«'Oiv` , CART <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. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> 1 <br /> T F rn <br /> m o a <br /> 1. All required dimensions or distances to be shown or drawn to scale. <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB) and indicate m <br /> North (N). (A <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s) to centerline of m I <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. x <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 /> I <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. R( <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be r <br /> signed and dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. IIJ( <br /> CONDITIONS OF PERMIT: g a <br /> N (Q <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 `n <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. v I` <br /> 5. Wttk acc ns� l,w s o, 1VX— WW -46 N� dor <br /> 6. <br /> Mg c y D D O m <br /> 7. m CmE> >mg <br /> = E <br /> 8. ?1 <br /> P <br /> m <br /> o : <br /> Ila : <br /> i c <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my in <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 /> 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 <br /> �i <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 ig <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. <br /> S <br /> SIGN HERE <br /> ( stun p nor or building contractor) (dab) [ o <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED P N o p ," N o m <br /> o $o g o o$ o N <br />