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071 60XV <br /> Burnett Cdunty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m - o 0 <br /> APPLICATION FOR LAND USE PERMITS d 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 in accor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other, <br /> 0 <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> OWNER /i �5 ) j/ TELEPHONE <br /> HOMEADDRESS <br /> EMERGENCY/FIRE NUMBER L / "/ ROAD NAMElie �Lj �p\\'1r• <br /> LEGAL DESCRIPTION(see tax receipt) C) <br /> CONTRACTORq/��,, / -f/- <br /> l I L/V �G <br /> 41 <br /> 1JJ o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION <br /> 0 <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION <br /> .0 a° <br /> STRUCTURE/ADDITION USE: S4-ff /T( y <br /> (Home/Cabin;Commercial Busine s; 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 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 <br /> a <br /> T Z (� a <br /> 1. All required dimensions or distances to be shown or drawn to scale. 5 P S <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate Inc: <br /> N: <br /> North (N). to <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of m <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, g� <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 'Q <br /> signed and dated by the owner. v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> 2. <br /> o �9 <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 ? <br /> PERMITTED. 9 <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 /> f <br /> 6. <br /> x °c 'S=R $ mm <br /> � <br /> 7. <br /> co =� 9 <br /> 8. <br /> z f = l �I m: [ M <br /> o <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m ` l E <br /> PP ( 9 Y 1 Y Y <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accurst of m <br /> 9 P g Po Y <br /> all information contained In this application(including any accompanying schedule)and I further declare that I recognize l o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ` o , o <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 Information I am p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other iQ E <br /> y <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. <br /> SIGN HERE e'e/V 5C h1271 <br /> (signature of owner o buildin ontra r) (date) o <br /> ZONING ADMINISTRATOR (q <br /> N NU 7 N N N U 7 -n <br /> TOW HIP PERMITS MAY BE REQUIRED o u u� o v u, w o m <br /> 00000SooM <br />