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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator v0 t m/�O <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes m — <br /> g hereby application for a Permit for the work desc ibed and m c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme Tits of the <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable Courtly O?ginances and the laws and _ <br /> regulations of the State of Wisconsin. F?15 a m <br /> c m <br /> 79 —�a3 <br /> OWNER TELEPHONE <br /> O ,p <br /> �� m <br /> ADDRESS g <br /> EMERGENCY/FIRE NUMBER 3 ROAD NAME OY'r 1 <br /> LEGAL DESCRIPTION (see tax receipt) N POU < G <br /> CONTRACTOR vv j 44A 5SAqr <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE _ ADDITION p <br /> o o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> 0 <br /> N <br /> r <br /> STRUCTURE/ADDITION USE: <br /> ( e/Cabi ommercial Business; Bedroom;Deck;etc.) Z <br /> 0 0 <br /> 0 <br /> m <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 (Vi),septic tank (ST),and drainfield (DF). <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,( )building 1A <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. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSME VERIFICATION BEFORE A PERMIT CAN BE ISSUED. o N <br /> PLOT PLANo? n <br /> 0 <br /> a � <br /> In <br /> I <br /> 0 <br /> IU <br /> O y <br /> n <br /> Z <br /> f <br /> D O C W rn DO In <br /> CONDITIONS OF PERMIT: <br /> m3: 30 ic <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m d': : �`'2 : : —4 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P E N <br /> 3, NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> i C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best o my knowl- o : � <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of II informa- i « m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize thatthis infor- <br /> motion 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 providingin this <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized pe n to have <br /> access to the above descr reml any reasonable time for the purpose of inspection. <br /> In y : <br /> 8 im <br /> SIGN HERE [ w t <br /> (a it to i ow or o bu ding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> «««y�y11 N«Nwr � T <br /> TOWNSHIP PERMITS MAY BE REQUIRED 8 N N O N UN«rN��9 m <br /> 8888888'8 U) <br />