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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator vU) o <br /> APPLICATION FOR - LAND USE - PERMITS m 3. <br /> TO THE ZONING ADMINISTRATOR:The here undersigned g DY makes application for a Permit for the work described and � w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m = <br /> Burnett County land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the lavrs and <br /> regulations of the State of Wisconsin. m <br /> w m <br /> OWNER `� '� �� TELEPHONE <br /> m � <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ROA NAME - 0K1 <br /> LEGAL DESCRIPTION (see taz receipt) L �l —( �l — <br /> CONTRACTOR- G l cl_ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/A CESSORY STRUCTURE ADDITION <br /> SANITARY <br /> PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o o J <br /> 0 - <br /> m � <br /> STRUCTURE/ADDITION USE: a <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> 0 0 <br /> 0 <br /> 3 <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 dralMield (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. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sig ed and <br /> dated by the owner. G <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSffE VERIFICATION BEFORE A PERMIT CAN BE IS3UED. I o y <br /> Z c <br /> PLOT PLAN <br /> M o <br /> 111 e 0 <br /> S C�'II •' <br /> Q �_ <br /> � l <br /> 0 <br /> o <br /> o <br /> w <br /> r <br /> Z <br /> IL <br /> MTChD>Om <br /> 84- <br /> g C_= ''m d <br /> e. D R. Ir O.w <br /> CONDITIONS OF PERMIT: < R. <br /> ,Z c S g . <br /> ra M <br /> i. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a it <br /> 9,2 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. y^,: =y' 33 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m I im <br /> S� <br /> ti : c <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- ° i <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- In <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that ihis infor- $ g p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue 8 permit. 1 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing n this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have ` o <br /> access to the above described premises at any reasonable time for the purpose of inspection. ? , <br /> m <br /> i m w <br /> N a : <br /> SIGN HERE N <br /> (signatures of owner or building contractor) (date) <br /> J111 � IIGYf�(l <br /> ZONING ADMINISTRATOR [ 8E <br /> NNN�+ MN� n <br /> N <br /> TOWNSHIP PERMITS MAY BE REQUIRED 8 4m N 8 N l �B m <br /> 88888888 ai <br />