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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR LAND USE PERMITS w 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- 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 w <br /> n ' I � v <br /> ke)aaAn/ and , Aaren N F,I$n!� TELEPHONE 7�5 <br /> OWNEI _3yn _a3SI w `= <br /> HOMEADDRESS )4OOS q41 /11- 70 t. p_n. " z8 I-�2r+o_lWI ti48�15 \ . <br /> �ti''?r �N , I A 1 <br /> EMERGENCY/FIRE NUMBER *t CL /Ltf£ aNN9� ROAD NAM .� ` i <br /> C d"A're� MQ/Sh <br /> /� Cy� Cl) <br /> LEGAL DESCRIPTION (see tax receipt) J,..,O 1' I , lJl 'l o 7I rY) 12fl Awl <br /> CONTRACTOR o <br /> � o <br /> TYPE OF PERMITS) DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION 0 <br /> N w <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo a <br /> � <br /> m <br /> STRUCTURE/ADDITION USE: /e W aor"k Qq m L, ' 14 <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) p 3 <br /> 'n a y <br /> T Z a <br /> 1. All required dimensions or distances to be shown or drawn to scale. m o a <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB) and indicate H <br /> North (N). m ' <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(OHWM) of lake, stream or river. r <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. <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. U) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> 2. <br /> ii <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: L <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> r W <br /> ISSUANCE. ` Oa <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY f� a <br /> PERMITTED. _ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. v I <br /> 6. <br /> Moc mm nEm <br /> A <br /> m <br /> F j I TQ <br /> Z _U <br />