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M C'o�/ <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator w m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <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 inaccor- <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. v <br /> o <br /> OWNER / iCL //� TELEPHONE �_ m' <br /> / m <br /> HOME ADDRESS % / <br /> ,! \� <br /> EMERGENCY/FIRE NUMBER ROAD NAME 3 Yd3 fW' <br /> Z_ o 0 40 <br /> LEGAL DESCRIPTION(see tax receipt) Mid <br /> CONTRACTOR / <br /> 0 <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE—ADDITION 0 <br /> m Or <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> Pit r�ra cam!^ <br /> STRUCTURE/ADDITION USE: KR _57be — TO A A F_ 3& <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> CT <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE C R <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 <br /> -n a rn <br /> TZ C <br /> 1 .All required dimensions or distances to be shown or drawn to scale. 5 P <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB)and indicate m y <br /> North (N). H <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerlin of m I �( <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. V 1 <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildings, Z <br /> roads, lake, lot lines. 1 �) <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. 0 I <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans mus be (7– <br /> signed and dated by the owner. Cn <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMI <br /> ISSUANCE.{I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 1 D <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF HE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> f <br /> 6. <br /> m (nv (nr > D <br /> 8aF <br /> x m <br /> am » <br /> 7. � :5 wcNag3 <br /> < N 0 O O a] <br /> Z f 7 TIN : M <br /> 8. m <br /> o : n � <br /> 0 <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the bes of m ` i [ <br /> PP ( 9 Y ) Y Y rAw m <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and aCCL racy of <br /> all information contained in this application(including any accompanying s'bhedule)and I further declare that Ireognize o o <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining wheth r to is. <br /> ` b , b <br /> o : o ; <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this informati in I am O p <br /> providing in this application. I ogre to permit county officials charged with administering county ordinances r other 3 ; 2 i <br /> authorized person to have acce3p4o the above described premises at any reasonable time for the purpose of insp action. <br /> N m <br /> w i <br /> SIGN HERE <br /> N ; <br /> (sl not re of owner r ullding contractor) (date) o <br /> 1 o : <br /> ZONING ADMINISTRATOR <br /> � -n <br /> N N T NN M <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 o D o m <br /> 0 0 0 0 0 0 o N <br />