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Burnett Courtly 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and H 0 <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 laws and 3 n <br /> regulations of the State of Wisconsin. rn d <br /> w <br /> OWNER aEKq�q P�.�IJ 69� TELEPHONE /(S- Lf U 7— o O <br /> ADDRESS � (� U�,1 /IRAO,IOG* WI - �I11DID000 UU <br /> EMERGENCYY//FFrIRE NNUUMBERT I VN !f 06f f ROAD NAME `JO <br /> LEGAL DESCRIPTION (see tax receipt) , <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION p <br /> n 0 <br /> SANITARY_ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> '^ r <br /> STRUCTURE/ADDITION USE: o 1 <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z <br /> 0 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 3 <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). r <br /> 3. Show dimensions infeet of thefollowing:(a) building to all lot lines,(b)building to center line of road,(c)building T <br /> measurement to the ordinary high water mark of lake,stream, or river. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. Q o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. an 3 N <br /> 91 Z Q <br /> PLOT PLAN 0 n <br /> m � o <br /> , 1 <br /> C II <br /> M <br /> prfiiq��co � <br /> I <br /> C7 <br /> N <br /> 0 <br /> o <br /> N <br /> Z <br /> D <br /> CONDITIONS OF PERMIT: 6: Z c 8 5 2 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f o Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. .'ter' O m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- : <br /> g� ' C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- i m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- ( v ip g p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 'o o <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. d, <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O N p <br /> access to the above described premises at any reasonable time for the purpose of inspection. r 3 'oo � <br /> m m A N <br /> N N <br /> SIGN HERE <br /> (sipna ure of owner or building contractor] r ( t i -'_ j;1\ E a' S m: <br /> 'I� li i O <br /> ZONING ADMINISTRATORWin <br /> TOWNSHIP PERMITS MAY BE REOUIR JUL o o u o 0 o N <br /> I <br />