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Burnett d-ounty 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administjrator d o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. — <br /> d s <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 ccor- 3 <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all ther = o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> OWNER •� _ /_N ELEPHONE C L <br /> �1 / I GC /' C/G/ v (- <br /> HOME ADDRESSCed O!� f L Ne 6J N R l 1 �J <br /> US <br /> EMERGENCY/FIRE NUMBER .KOV90 ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) G� G. L. ` ,- Z] <br /> CONTRACTOR �� L /' O O <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE---XADDITION G <br /> N r 1 <br /> 0 <br /> o <br /> SANITARY PRIVY P ILL NGIGGR DING CAMPING UNIT"—SUBDIVISION o <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Comm rcial usiness;)13edr m;Deck;etc.) 33.4Q Ff 4 Jr <br /> – o Ger G-2 0 _ <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) m a rn <br /> T Z <br /> 1. All required dimensions or distances to be shown or drawn to scale. m <br /> <, <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB) and indicate m LU N <br /> C S_ <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 build gs, <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 Z <br /> signed and dated by the owner. Irl <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION E- <br /> FORE A PERMIT CAN BE ISSUED. v �} <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. m <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERM T l� <br /> ISSUANCE. \` <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 9 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE Q J <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. r <br /> 5. <br /> f <br /> 6. // / / <br /> (-eta 14 114 Ck e d �LO ?IA NVj 9- C � rn� 8 > F m <br /> M94 - 60 <br /> Q 0 o <br /> O E ' N <br /> 8. 62 E m <br /> o E y <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the b at of my ' w i ? m <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and ac ;uracy of Yn''m V G <br /> oc o : <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that 1 cognize m b , <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining who ter to Is- <br /> sue a permit. I further accept all liability which may be a result of the County of Bumett relying on this Informi don I am ? m o <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinance or other <br /> 3 : <br /> 3 : y <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of In petition. •n : , , <br /> SIGN HERE <br /> at of owm building contractor) fF <br /> 1 <br /> g : <br /> ZONING ADMINISTRATOR �y <br /> ly\ NNNNNNfT m <br /> TOWNSHIP PERMITS MAY BE REQUIRED - " 0 8 8 8 8 8 8 8 (a <br />