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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ; o o <br /> APPLICATION FOR LAND USE PERMITS 3 _TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work <br /> m <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- 3 R <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. y m <br /> OWNER TELEPHONE 3.v 1� <br /> \-AcEK (o\z-4f6- 345e> <br /> HOME ADDRESS �t) O V-- S-,C, SE ATc o5 thQ4`�11+\ti js6i/ <br /> EMERGENCY/FIRE NUMBER -�$\Ac O ROAD NAME <br /> �S!^ Vo\.,\o P. \33 bl.Kw�o <br /> LEGAL DESCRIPTION(see tax receipt) l/4 Y'4r- 23/\4r O W Az (p/_Iw L or <br /> V. A/1. G.\.N (— <br /> CONTRACTOR 1 <br /> 0. SEVE0.S0'^1 G.Ow1ST �'O 4\ \ C.. 5J —CS� o o h� <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE <br /> —X__ADDITION 0 <br /> N � <br /> O <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISIONv <br /> Z a <br /> m <br /> 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. r O <br /> OILII Y»J <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) A <br /> O 3 <br /> T P ti <br /> 1. All required dimensions or distances to be shown or drawn to scale. n o S <br /> 2. Show the location and size of all existing buildings(EB)and all new buildings (NB)and indicate m y: <br /> North (N). C <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. (f <br /> 4. Show the location of the well (W), septic tank (ST)and drainfield (DF), and all distances to buildings, <br /> roads, lake, lot lines. <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. p <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be (1 <br /> signed and dated by the owner. 0 o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. nt�9 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> N <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. j <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY a <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 /> 6. <br /> 7. y o c� $ m <br /> s» = � <br /> p J Q i <br /> 8. z fes ; Wiz ; -t <br /> L" � 2 m <br /> o : dam : D <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 /> 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 o: p <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 promises at any reasonable time for the purpose of Inspection. m <br /> SIGN HE:�EDIINISTRATOR <br /> N ; <br /> an uro of ow ar r building contractor) (date) <br /> i o i i <br /> ZONING MW <br /> N N N N N N N m <br /> TOWNSHIP PERMITS MAYBE REQUIRED 0 8 0 0 8 0 0 0 fmii <br />