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0nG>rnyl <br /> Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator � 3 E o <br /> APPLICATION FOR LAND USE PERMITS u s <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work o <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- 3 g ) <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other - m <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. m Rj <br /> OWNERD TELEPHONE/I�_�G�3._IOLfo m <br /> Lai 17J v SI1 t7 � �Q <br /> HOME ADDRESS lame U13 5�GlI� � �et` I <br /> 2 0.YY <br /> EMERGENCY/FIRE NUMBER ROAD NAME 11e <br /> LEGAL DESCRIPTION(see tax receipt)/-T I ' <br /> CONTRACTOR IQII�S'PrJ ��N�T O VJtt''� ��de`�1C V 9 o G9 <br /> N <br /> TYPE OF PERM (S):DWELLING/BUILDING_ Z_GARAGE/ACCESSORY STRUCTURE ADDITION <br /> o' <br /> v <br /> SANITARY PRIVY FILLING/GRADING CAMPINGUNIT-SUBDIVISION o a <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial usiness;Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR r <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) r v <br /> T Z R <br /> 1. All required dimensions or distances to be shown or drawn to scale. 3 P <br /> U) a. <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate M <br /> North (N). w <br /> m <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of d <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, �— <br /> lake, lot lines. O <br /> as to be graded or filled. <br /> 5. Indicate if a walkout basement is planned and show are <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be F <br /> signed and dated by the owner. �' R <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- h' <br /> FORE A PERMIT CAN BE ISSUED. N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> Cnnininnhlc OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I~�j <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 1 D <br /> PERMITTED. /1111 <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. f <br /> 6. <br /> 7. a < H' E Z mo Win' ; <br /> co 'o' i ' -Q i 1 <br /> Z s [ _!rn 9 <br /> 8. <br /> D <br /> qq ate ; C <br /> : �, <br /> I declare that this application (Including any accompanying schedule) has been examined or me and it the bests my m , O <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ; o n o': <br /> all Information contained in this application(including any accompanying schedule)and I further declare that 1 recognize ; 8:c 81 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Is- <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 i i <br /> 0i <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. $ <br /> N ; <br /> SIGN HERE - (dab) <br /> sign n of ow o wilding contractor) �I <br /> ZONING ADMINISTRATOR <br /> N N N N N N f l m <br /> fn V, ONNNO m <br /> TOWNSHIP PERMITS MAY BE REQUIRED $$$$$ 0 8 rn <br />