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Burnett County 7410 Co. Rd. K, No. 102, Siren,W154872 Offka of Zoning Adminilstrator 0 m o 4 <br /> APPLICATION FOR - LAND USE - PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work tland <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requinescn sof the o c <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the I ws and . SL <br /> regulations of the Stale of Wisconsin. m <br /> m <br /> m O <br /> OWNER TELEPHONEC <br /> ADDRESS , <br /> O O fa( Y <br /> EMERGENCY/FIRE NUMBER ��- ROAD NAME 2 <br /> LEGAL DESCRIPTION (see tax receipt) -s— e7i <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O (� <br /> SANITARY PRIVY FILLING/GRADING r1TCAMPING UNIT SUBDIVISION o <br /> O O / <br /> STRUCTURE/ADDITION USE: � <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o 0 <br /> 0 <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). a <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. Q <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be si ned and 9 <br /> dated by the owner. Q o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE UED. 71 c o, <br /> 71 Z c <br /> PLO � ,, -0) <br /> o <br /> C ' <br /> 0 O <br /> MLV <br /> L <br /> 01d ffa Slot �,� <br /> N <br /> 7 O <br /> 0 <br /> A-r JIB) <br /> ^ m <br /> O � <br /> U y <br /> v p <br /> 1 Z <br /> MX (n-Dn017 <br /> CONDITIONS OF PERMIT: o w; Z c 'gm ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN a0 DAYS OF PERMIT ISSUANCE. o F <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =r= <br /> ' aE <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 't�' "' Q E ` m <br /> Qj gE ` C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best c f my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy ol all informs- •+m�^ m <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize th t this infor- $B O <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $19 $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providl gin this ap- <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized pe ion to have <br /> access to the above cleric premises at reasonable time for the purpose of inspection. <br /> m o <br /> SIGN HERE C. ` <br /> (signature of owner or b1dig Int or) (date) ; 8E <br /> ZONING ADMINISTRATOR Ar - g <br /> uveae r'uie, u m <br /> N N N N N <br /> TOWNSHIP P ITS MAY BE REQUIRED o u v 15 n u N <br /> j 88888'$ y <br />