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0-,,u <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator rn o 0 <br /> APPLICATION FOR LAND USE PERMITS w 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit fort <br /> he work <br /> in j(€�ccor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with al other <br /> described and located as shown herein. The undersigned agrees that all work shall be done 3. <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y w° <br /> OWNER L {' FL <br /> �f1J,Jt EPHONE <br /> HOME ADDRESS <br /> 6//77 <br /> d m4A 1Ef�u/r S r z <br /> EMERGENCY/FIRE NUMBER ROAD NAME / <br /> d et l <br /> LEGAL DESCRIPTION(see tax receipt) CLt <br /> G' 4. — Xe, ry _ 7'37iv 1,p k <br /> rF <br /> CONTRACTOR .fe / <br /> L o rD <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE�// '' o <br /> DDITION ' o <br /> 2 <br /> N O <br /> SANITARY PRIW c <br /> FILLING/GRADING CAMPING UNIT SUBDIVISION -0 <br /> STRUCTURE/ADDITION USE: — T <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) _ <br /> r <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE O <br /> lt <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 <br /> a Cn <br /> 1. All required dimensions or distances to be shown or drawn to scale. n o c <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB) and indicate FL <br /> m ( S <br /> North (N). C 0 <br /> 3. 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(OHm <br /> WM) of lake, stream or rive . <br /> 4. Show the location of the well p ( ) <br /> (W), septic tank ST and drainfield (DF), and all distances to buildin s, �J <br /> roads, lake, lot lines. C) <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. 1 <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must e <br /> signed and dated by the owner. <br /> Jjy <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE 8 <br /> 8 <br /> FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> _CONDITIONS OF PERMIT: <br /> 0 <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. p <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THEI� <br /> 5. OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 6. �9 _ / / �j 1 F <br /> 7. �Pe f17�/ d T�O7 �j,✓ 2 C m w �8 $ m <br /> a � m <br /> iv <br /> 8. <br /> Z f ' T� <br /> N' �� : m <br /> of m O <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best ol my 1�n ` E m <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accurac of '• <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recog Ize7W ' <br /> om o : <br /> that this Information I am providing will be rolled upon by the County of Burnett Wisconsin In determining whether t is- <br /> sue a permit. I further accept all liability which may be a result of the County of Bumett relying on this information I am <br /> providing in this application. I agree to o' <br /> g permit county officials charged with administering county ordinances or o her ` 3 � $ <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspecti <br /> SIGN HERE <br /> ( taroof ow r or building eonVaetoq�, n ! ate) N <br /> ZONING ADMINISTRATOR - Z o ! o <br /> TOWNSHIP PERMITS MAY BE REQUIRED O N N O N u, w O m <br /> � goo $oogfA <br />