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�)(L C nop <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator Um o 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Z w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the M m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. <br /> w � <br /> C <br /> w 0 <br /> OWNER -TIM 1 f'�/f IJT 1 TELEPHONE o £ <br /> r 1r-1 I�LVE <br /> ADDRESS L30 S 6REE)V r'IIV - 96W Ric HMOA/0 -, Will , Sgol � w <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> ) <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR I TrT <br /> l � <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION o � <br /> m V <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o o <br /> J <br /> w � <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) Z T <br /> 0 0 <br /> a <br /> } <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 9 <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). (S+t <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. 0 N <br /> NOTE, BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. in o w <br /> 7I z Q <br /> PLOT PLAN o a <br /> 0 M o <br /> U O J <br /> fA <br /> �ACHE►� <br /> fN` 1 <br /> � o <br /> N J <br /> O Ir <br /> D <br /> w_ <br /> n <br /> Z <br /> / C <br /> MM c w IT 0 a <br /> pg� 2..aN emm <br /> CONDITIONS OF PERMIT: C8 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z 0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. o <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. NNop <br /> o ; <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- iN yr m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- ii; 5 : p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 g`� $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have O p <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> /I''/ /!NA N w <br /> SIGN HERE 1 firms D E N .8 i <br /> (aipn ure of owner or building contractor) ------ �' <br /> ZONING ADMINISTRATOR ? ? E g d S E E <br /> NNN NNNN "t <br /> TOWNSHIP PERMITS MAY BE REQUIRE u� o N Iuoq"��yq� N d N m <br /> I oo �✓ .goo N <br />