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Burnett County 7410 Co. Rd. K, No. 102, Siren, Will 54872 Office of Zoning Administrator 0 Uo 1 V <br /> APPLICATION FOR — LAND USE — PERMITS0 a <br /> TO THE ZONIN3 ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett Co;fnty Land Use Ordinance,Sanitation Code,and with all othQQQr applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. <br /> VVacr n II <br /> OWNER L�rG,o� TELEPHONE a 0 <br /> ��qy II�-,I I ' I ILLLL,� �Q <br /> ADDRESS CI "hR�(IV,,... � ADl� M�� i` m � <br /> EMERGENCY/FIRE NUMBER 1�U11 ROAD NAME n; <br /> _lw <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p a <br /> SANITARY PRIVY FILLING/GRADINGCAMPING UNIT SUBDIVISION /\ o` = <br /> r <br /> STRUCTURE/ADDITION USE: o ° <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ZO <br /> o ° <br /> 9 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). I o <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building - <br /> measurement to the ordinary high water mark of lake,stream,or river. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. 0 0 �y1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a N 1 <br /> c =� <br /> PLOT PLAN A o n <br /> m <br /> -Pv IIIrV i <br /> / O <br /> lim <br /> << o <br /> o-' UI <br /> n <br /> + Z <br /> i <br /> F <br /> S <br /> O C m O N T ,.D Mm <br /> m m n Q F <br /> v <, : `Z IO <br /> CONDITIONS OF PERMIT: m. C O J <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F T� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. = »� . rpit <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ro ,cc„ : OC <br /> $ c : <br /> a , <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- . '" : <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 1 8 R a <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ m $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this ap- <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O P p <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 8 R <br /> 3 x : <br /> m m A N <br /> M N <br /> SIGN HERE H a <br /> (signature of owner or tuilding cont racto (date) x. <br /> ZONING ADMINISTRATOR ) I $ <br /> TOWNSHIP PERMITS MAY BE REQUIRED8= N 8O, m <br /> m <br /> N N N <br /> Pulp 0 0 <br /> $ $ ggggN <br />