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aLJ,UJ <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m 0 0 <br /> APPLICATION FOR LAND USE PERMITS '- 3 <br /> w o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work � m <br /> described and located as shown herein. The undersigned agrees that all work shall be done i i accor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with II other <br /> applicable County OrdinanceDs and the laws and rregulations of the State of Wisconsin.1 y m <br /> OWNER / TELEPHONE /.S ✓3 � iD 7S m v <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER /(�/� ROAD NAME eer <br /> LEGAL DESCRIPTION(see tax receipt) O ✓l' <br /> �Q Vr <br /> CONTRACTOR / <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ CCESSORY STRUCTURE ADDITION o to <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION Z v <br /> STRUCTURE/ADDITION USE: r / <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 R m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In <br /> I(, , <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 l)J <br /> T v c <br /> 1. All required dimensions or distances to be shown or drawn to scale. z g <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB) and indicate m m H <br /> North (N). y (� <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) building(s)to centerli a of m <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or ri er. <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 <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans mus be C <br /> signed and dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- W 0 <br /> FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF P RMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF <br /> ISSUANCE. PERMI <br /> IW <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 THE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. I r <br /> 5. <br /> 6. <br /> 7_ m n v n a a o y <br /> �2' of m <br /> Ram RM <br /> Z . IC m o = M <br /> 8. <br /> G <br /> m <br /> O <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best Of my m , ! m <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accur cy of In <br /> all information contained in this application(including any accompanying schedule)and I further declare that I rec nize <br /> om o ; <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- o o <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this informatio lam <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or cher <br /> m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspe(tion. <br /> m m <br /> SIGN HERE <br /> (e ahature of owner or building contractor) ? o <br /> (date) o : <br /> ZONING ADMINISTRATOR 0 <br /> f <br /> TOWNSHIP PERMITS MAY BE REQUIRED N o on N o m <br /> 00000000) <br />