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�? `�-, <br /> Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator rn -uo <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work g <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- ` <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other 3 <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. H m <br /> N <br /> OWNER T PHONE <br /> HOME ADDRESS �\ <br /> UC G te t- AIO DMS t�? t/. 51 <br /> w <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CONTRACTOR 4, L <br /> a 3. <br /> TYPE OF PERMIT(S): DWELLINGBUILDINGRAGE/ACCESSORY STRUCTURE ADDITION. o" ,�..- <br /> N y ' n <br /> SANITARY PRIVYV ' <br /> O FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> Z <br /> 'o <br /> 3 a <br /> STRUCTURE/ADDITION USE: I/i T. A U&TT p/J 20>eZ9' f51K A-Dr) L 60 166 2,4 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR N-3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m N <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> O 3 <br /> T 'o N <br /> 1. All required dimensions or distances to be shown or drawn to scale. n o 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). tC 0 1 <br /> 3. Show dimensions in feet of the following: m CI <br /> (a) building(s)ng(s) to all lot lines, (b) building(s)to centerline of I � <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildings, ()j <br /> roads, lake, lot lines. <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. rs U) <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be sI I <br /> signed and dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE U <br /> FORE A PERMIT CAN BE ISSUED. <br /> IP <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <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. :b <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE <br /> 5. OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. t <br /> 6. 4g4 /� p <br /> fff��'7. <br /> �l//� <br /> m <br /> y <,N, `Z . 0 �f0 <br /> 8. F Q_Q : 1 <br /> —.co: <br /> ca : m <br /> d <br /> C <br /> a ' <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detall and accuracy of p <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize 0 0 <br /> that this information 1 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 Information I am ` <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other i 8 <br /> 0 <br /> authorized person to ss to the above described remises at 3 <br /> P y reasonable time for the purpose of inspection. T . p m <br /> SIGN HERE _ �, <br /> WOWNSH,PPERM,TS <br /> ( Ld ZONING ADMINISTRATOR1E REQUIR ,t ! 2 �� ) o o N o m <br /> !�u I , S 888888ai <br />