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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o 0 <br /> APPLICATION FOR LAND USE PERMITS a 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work 12 <br /> � y <br /> described and located as shown herein. The undersigned agrees that all work shall be done inaeeor- 3 <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other - o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y m <br /> A /'2f�ltt!E 30) -S3v- Z036 8 <br /> OWNER TELEPHOOE_ 6 -Ik96 -333e64A1I1 <br /> 02, <br /> {JA c� m t� <br /> HOME ADDRESS //� �1 / `S,C= /�( �N�//EW /'//�J L"S'/6 y <br /> EMERGENCY/FIRE NUMBER 6 0.5 ROAD NAME F/Owd c- I �o <br /> �Irr//LL77 Q. <br /> LEGAL DESCRIPTION(see tax receipt) TQ/f 16 W G S/n V 13 <br /> CONTRACTOR /N — <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ✓ GARAGE/ACCESSORY STRUCTURE ADDITION 0 <br /> N w RJ <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION � <br /> STRUCTURE/ADDITION USE: <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. m (J`t <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> -n a y <br /> n o c <br /> 1. All required dimensions or distances to be shown or drawn to scale. n <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB)and indicate m y: <br /> North (N). to <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of m i f <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. a <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. Ui _ <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. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. fi <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW.CONDITIONS OF PERMI , <br /> U� <br /> v <br /> N_ <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 TJ ? <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 FEET OF THE <br /> OHWMIOF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. Q <br /> 5. Or Sfr�u(oA4eS mkbt- L.e pleUecl )efbeeti 6A5000 71 <br /> - fill e,xCV A 5 ,� <br /> o•l � & Seedgd+ML�I�d � <br /> 6' oh SOcieleA ZmrnedmteL tD orejelt+ eeoC S°ti• <br /> 4 �o Rao = a� � m <br /> m 9 <br /> n am » <br /> e mN: Qmo °=m 3 <br /> o : i k-4 <br /> Z f TN >7 <br /> 8. rn <br /> o - <br /> o <br /> a c _ <br /> I declare that this application (including any accompanying schedule) has been examined <br /> by me and to the best of mym <br /> knowledge and belief It is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of 23 E O <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize4 <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether .to Is- ! 0 : 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 p <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> ` <br /> B <br /> SIGN HERE - '; [ 0 <br /> n ureof ownr r eIltling contractor) !r^ ',.idea) i ? i o E <br /> ZONING ADMINISTRATOR <br /> wvr Fn j't»Fn`n TT <br /> N N N N N N (!t m <br /> TOWNSHIP PE MITS MAY BE REQUIRED <br /> !I <br /> 000g0000 (A <br />