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ff) %n ) <br /> Burne#County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator d T%n) <br /> 0 <br /> APPLICATION FOR LAND USE PERMITS v <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- 3 a <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. N m <br /> ^� bla q4(.- 119413 (tn-F M v <br /> OWNER JANN E � (IA LLELf TELEPHONE 9IS 6S6 <br /> wefitt ElJO I? � aI <br /> HOME ADDRESS93-4v C` eev, 1K�►oLL ko E DEN PRA I R t C M N .S S 3 41 N <br /> EMERGENCY/FIRE NUMBER O?q,7 5 ROAD NAME <br /> �nt - !/I <br /> —A K E Ri <br /> 33-31 535 15/ 535/-2 5!C PCL Gov L6-r 1 <br /> LEGAL DESCRIPTION (see tax receipt) 5 33/TSI/Rf b w G•-7Lcv A c"5 SEC 334- /J W 5 Y.J <br /> o5 <br /> 654TH ESMT CESG -35A-S3 <br /> CONTRACTOR GREG ��..�� q V 1 <br /> (D <br /> o <br /> TYPE OF PERMIT(S):DWELLINWBUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ----- O <br /> G <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> z o <br /> jj�� m <br /> STRUCTURE/ADDITION USE: I)E clee <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. m <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) p <br /> m -o <n <br /> C <br /> 1. All required dimensions or distances to be shown or drawn to scale. n o a <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate M (IJ o <br /> North (N). co <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. <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildings, W -� <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 <br /> signed and dated by the owner. CD <br /> 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- (A ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> 2.0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT p <br /> ISSUANCE. W <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ', z <br /> PERMITTED. SIJ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE <br /> OHWM OF LAKES, PONDS, RIVER UN ESS SPECIFICALLY PERMITTED. <br /> 5. <br /> 6. <br /> M 0 m con m <br /> oa � � <br /> 7. 0 :13 CmCL M <br /> o � 3 <br /> a <.o. m� .fc - <br /> Z fes ; �1�; i M <br /> ° a* m <br /> 8. 0 6 2 O <br /> o S CL C <br /> o `D <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my O <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of O <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize o o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- 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 1 am i 0: p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ; 3 ; 4 `• <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T i CD <br /> a i y <br /> SIGN HERE <br /> Sig Lure of owns r ull n contractor) `�' (date) 0 : <br /> ZONING ADMINISTRATOR I <br /> N N(n F.) M <br /> TOWNSHIP PERMITS MAY BE REQUIRPD ',j� o 0 000 0 0 0 o m <br /> o0000000fn <br />