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11 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ,� 0 0 <br /> APPLICATION FOR LAND USE PERMITS 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 actor- `g <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other - o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> /+� 0 <br /> OWNER �,, a- lt..���.. ( lhi'f� TELEPHONE 666- V01 /iry-3619 <br /> m <br /> HOME ADDRESS 70-1_ Ybla S4 , <br /> EMERGENCY/FIRE NUMBER q)V)'j _s}a f ROAD NAME rn "j l 'tae.dL <br /> LEGAL DESCRIPTION(see tax rete' t) L 6 t C S vt'L V p $ La T C f y <br /> Ili TIC-) <br /> CONTRACTOR <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION <br /> 0 <br /> O (� <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION- <br /> STRUCTURE/ADDITION <br /> UBDIVISION STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <br /> r <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. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 <br /> 'I 7 N <br /> T Z a <br /> 1. All required dimensions or distances to be shown or drawn to scale. m o a <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB)and indicate y <br /> North (N). w t ' <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) building(s) to centerline of m -I-- <br /> road, <br /> J=road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. SU c <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildings, 47- <br /> roads, <br /> Groads, lake, lot lines. I <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. I <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be — r <br /> signed and dated by the owner. 0U) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. N UZ _ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <br /> 5. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT f <br /> ISSUANCE. lJ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY F <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 /> S oc=. � cDi f m <br /> Z f ' : : Tom1 M <br /> 8. P ui i 25 2 i i m <br /> r, A <br /> c � <br /> o ' n C <br /> 0 . <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> oua o : <br /> all Information contained In this application(including any accompanying schedule)and I further declare that I recognize <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 0: o <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other 3 ? i� <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T ? m <br /> N t <br /> SIGN HERE <br /> ( n ureof building contractor) '!I�,' (date) <br /> �t� !�l i o 1 i <br /> tJRI i <br /> ZONING ADMINISTRATOR <br /> L9 <br /> M M <br /> TOWNSHIP PERMITS MAY BE REQUIRED _ ou u oun u, o m <br /> �� _, o $ o $ ogooUl <br />