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(z- - <br /> Burnett-County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> d 0 o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 2 N pQ <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 3 a <br /> regulations of the State of Wisconsin. y m <br /> OWNER ` >/ `�— TELEPHON <br /> ADDRESS �� / / �� �' • 1 FYLI I I'/'!/V �J I m <br /> EMERGENCY/FIRE NUMBER 6 ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) (� <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O I O <br /> 0 "l <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> STRUCTURE/ADDITION USE: 4 wzz- J P8 t yy d \ t. rt� 6" o a <br /> (Home/Cabin;Commercial Business; Bedroom; Deck,etc.) Z v <br /> o ° <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 drainfieid (DF). <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. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a w <br /> c <br /> PLOT PLAN = <br /> Li <br /> `(s /�G M ° <br /> C <br /> a � <br /> TO <br /> Sem r irQ�� t }e L1ipe�ors�Lu <br /> Z-4 <br /> I I <br /> I � <br /> I Z <br /> I a <br /> I I _ <br /> I <br /> �AYsr(�� ow (p- 15-ay I I f <br /> ���Cyn"`d w. m I-Nhrkr –SYa�r Iticuw �+ I — _ ��LiL✓'d — l <br /> Nub Rtby-a /}Ria!►, �'c n f <br /> _ <br /> — 2.n'n p wm <br /> — <br /> CONDITIONS OF PERMIT: a m=, Q c 8 0. ro <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Pee''kr£ '^y =N M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 1. No : j 0 o : mO <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- c m C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- a a M <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- s is m <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o'$ <br /> funher accept all liability which may be a result of the County of Burnett relying on this information I am providing in this a - <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. m c OR m <br /> m <br /> G m m <br /> SIGN HERE / a/ <br /> (sign re f owner or Ing contractor) (dal ) — - 8 <br /> ZONING ADMINISTRATOR <br /> �N m N g p <br /> TOWNSHIP PERMITS MAY BE REQUIRED o o In m 1T u m <br /> AOD u,a <br /> bb o� o�S'� c� (m/1 <br /> en <br /> 0 <br />