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Burnett.Gounty 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator w M 0 0 <br /> APPLICATION FOR LAND USE PERMITS <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 actor- mS. <br /> �! <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other 3 o W <br /> applicable County Ordinances and the laws and regul tions of the State of Wisconsin. <br /> OWNER ��rIS I1! �� V IUGR �/t10N TELEPHONE /r2""7�V -J /6 p !J <br /> -t•Fc,�c itTE'S, <br /> HOME ADDRESS Le)4 tf Z- to *Ar-o- cre- &� ,_j <br /> EMERGENCY/FIRE NUMBER ROAB!lAMG 7c lan�/ 1 <br /> N(see tax receipt) 2 tN C1xJ �c-��n7s 1,�2 �ct7`ze►.. LZ Pc v� <br /> J <br /> CONTRACTOR <br /> l�.ltit7A�her � /"�i1�rrSON � <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> N rc <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> CD <br /> o ° <br /> / <br /> STRUCTURE/ADDITION USE: dlu/n/ D <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. O (� ) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 !` <br /> n a ti <br /> T o Cr <br /> yr All required dimensions or distances to be shown or drawn to scale. t7 <br /> I-r Show the location and size of all existing buildings(EB)and all new buildings(NB)and indicate m y <br /> North (N). m Cs <br /> L,r Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. 10 <br /> UA) Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildings, <br /> roads, lake, lot lines. <br /> L*- Indicate if a walkout basement is planned and show areas to be graded or filled. I <br /> ►-9r� if separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be <br /> signed and dated by the owner. <br /> MOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> 00 <br /> CONDITIONS OF PERMIT: o <br /> t. 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. �b <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY I ? <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE �- <br /> OHWM OF LAKE , PONDS, RIVER UNLESS SPECIFICALLY PERMITT D. <br /> 5. J�^E' �^6q/ )�-OV' S/�n <br /> 6. <br /> p�p»p�rD DF <br /> oc �. ww8Rm <br /> 7. <br /> 2. CL m » `D � <br /> 2 _ cn m <br /> 8. m <br /> O a C <br /> O N <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my ; m <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 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 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 0 o ' 0 . <br /> ; o : <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 0: o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other3 ? 8 <br /> authorized personav ccess to the above descri premises at any reasonable time for the purpose of inspection. r ? w <br /> N <br /> -� <br /> SIGN HERE ,pew <br /> ature Of or building contractor) <br /> 7`/b i jo <br /> ZONING ADMINISTRATOR E E <br /> NNNN. Vt <br /> TOWNSHIP PERMITS MAY BE REQUIRED O v, v, o u, 0 o <br /> 000000 ' o <br /> 000000 0 <br /> �8 <br />