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Burnett.County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U 'a - o <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> d O <br /> TO THE ZONING 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 <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and y. o <br /> regulations of the State of Wisconsin. <br /> m � <br /> ' ` m O <br /> OWNERVI)q C U M M ) O! S TELEPHONE G 12 _ Q /..(n n F <br /> ADDRESS �►\ G f_ e� 11 'Z <br /> 12 W r-� _5s <br /> EMERGENCY/FIRE NUMBER 1l ROAD NAME ry \ <br /> t J <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> 6J- <br /> Ttz <br /> YPE O MIT(S) DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION nrNJ <br /> O <br /> SANI PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> STRUTU <br /> RE/ADD N or- <br /> K <br /> USE: o <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) _ <br /> 0 0 <br /> a <br /> a <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). O <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). 1— o <br /> 3. Show dimensions in feet of thefollowing:(a) building to all lot lines,(b)buildingto 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 M <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7i o m <br /> PLOT PLAN Z <br /> fn - o <br /> C <br /> a d _ <br /> 8 <br /> Q-) <br /> m <br /> �c\ <br /> N v <br /> o <br /> J <br /> J <br /> b <br /> O � <br /> m <br /> " d <br /> Im <br /> NNl7 fnr DDOIm <br /> CONDITIONS OF PERMIT. <br /> o < ' m c m o 5 ic <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F ? U0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. = r^ m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED.' ro » : C <br /> 8 € = s <br /> n , <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 informa- . fn m fn O <br /> tion contained in this application(including any accompanying schedule)and I further declare that t recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 8 '? 8 <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 — N O <br /> access to the above described premises at any reasonable time for the purpose of inspection. 8 <br /> M ? A a i <br /> rJ - -- i 8 <br /> SIGN HER r __ <br /> (signature,of o iltli ontractor) jI � j-- - (d <br /> ZONING ADMINISTRATOR <br /> TO NSHIP PERMITS MAY BE REQUIRED0 <br /> ro � '0 8 m <br /> , N N <br /> -- / $ <br /> 8888 vi <br />