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Burn" County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work describe and (� <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the $ i <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the la s and _ <br /> regulations of the State of Wisconsin, w E <br /> u � <br /> l c <br /> OWNER J\C1 ,, S J"t TELEPHONE <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME 1 n <br /> LEGAL DESCRIPTION (see tax receipt) <br /> i <br /> CONTRACTOR J ' � <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> lSANITARY PRIVY FILLINGGRADING CAMPING UNIT SUBDIVISION o <br /> o = <br /> STRUCTURE/ADDITION USE: 5e,,, 0 <br /> = V <br /> (Home/Cabin;domm&al Business;Bedroom; Deck;etc.) Z <br /> 0 O <br /> �1 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). f- <br /> 2. Show the location of the well (N),septic tank (ST),and dralnfield (DF). <br /> 3. Show dimensions in feet of the following:(a)building to all lot linea,(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 sago d and <br /> dated by the owner. <br /> 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISS ED. 'tl 3 m <br /> c <br /> PLOT PLAN o n <br /> Ili o fFkr'�''� <br /> C <br /> a ) <br /> m <br /> r <br /> N <br /> J � <br /> 0 <br /> m <br /> R � <br /> r. I <br /> Z <br /> r � <br /> G <br /> m <br /> CONDITIONS OF PERMIT: 33 <br /> NO <br /> g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z ai o':P �'z'—I —4 <br /> FSE ntl - <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m <br /> 1 declare that this application(Including any accompanying schedule)has been examined by me and to the best of ml knowl- O <br /> � ` C <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all i forma- «Is to. <br /> m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that in s infor- 8 ? p <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $� $ <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 p <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> IS <br /> w w <br /> SIGN HERE <br /> (signature of ow r or buildln t or) (date) <br /> ZONING ADMINISTRATOR <br /> a www ' -1 <br /> TOWNS PERMITS MAY BE REQUIRED R R$ m <br /> 8 $ 8$ ai <br />