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64 (") <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator w - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work6 <br /> described and located as shown herein. The undersigned agrees that all work shall be done in accor- mTL <br /> 5 <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other 3 <br /> 0 <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y R <br /> v <br /> OWNER ONa LrS Lr1 1Jlf�rJi: AACsLIA TELEPHONE ?1 `J�IQ�0�6 'Q-(o�o5 m <br /> O w <br /> HOME ADDRESS 0-70 <br /> -7O 0,0,L - j <br /> EM7 <br /> EMERGENCY/FIRE NUMBER w ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) �'O'3/ 3g /� // , 1 4L <br /> CONTRACTOR !10 til! b <br /> �I o <br /> G) <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTUREADDITION 0 <br /> N M <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION Z o (L <br /> ` o v <br /> STRUCTURE/ADDITION USE: S fo rQq�' w <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O B <br /> Cn <br /> cr <br /> 1. All required dimensions or distances to be shown or drawn to scale. n P <br /> CL <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB)and indicate m y. <br /> North (N). W <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of m (hl <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, <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 I <br /> signed and dated by the owner. R <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> N <br /> O <br /> 7 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: 4 <br /> 3. <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 ? <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. <br /> 5. <br /> 6. <br /> �� 2_.o-c o.m m <br /> 7. m .: <br /> CD CD <br /> v m cc <br /> o i W.Q <br /> 8. P <br /> u : 62mA <br /> o ate ; C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my w m <br /> knowledge and belief it is true correct and complete. I acknowledge that I am responsible for the de it and accuracy of ? (n , En <br /> 9 P 9 P Y N w 0 t7 <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize o m o <br /> o , o i <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- I 0 : 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 0 0 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ? 3 <br /> authorized person to have access to the above desyflped premises at any reasonable time for the purpose of inspection. y N <br /> m <br /> SIGN HE r 1 �/ w <br /> N <br /> (sture of owner or building contractor) <br /> O <br /> (dale) o <br /> i 0 <br /> ZONING ADMINISTRATOR41E� -2 <br /> vi Entn�tnE»E»� 71 <br /> NN0 rNN VI M <br /> TOWNSHIP PERMITS MAY BE REQUIRED P `� P v, o m <br /> 00000000 <br /> 00000000N <br />