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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator to ', -4 Z <br /> W m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and o 0 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. o <br /> m m <br /> m � <br /> OWNER �/� Q11 le�Pjse /J }�TELEPHONE <br /> i <br /> ADDRESS13a <br /> V�rQ '(J l�kV m <br /> EMERGENCY/FIRE NUMBER ROAD NAMEAA /0,j <br /> 1aKe /fd, <br /> LEGAL DESCRIPTIONsee tax recei t) /r <br /> CONTRACTOR 'S <br /> r�Lc �ehc/ ��n✓ C� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION �� p <br /> o <br /> SANITARY y PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION rG <br /> / <br /> ` N �f <br /> STRUCTURE/ADDITION USE: /�`p/k�( o g <br /> (Home/ abrin;Commercial Business;Bedroom; Deck;etc.) Z <br /> O <br /> a <br /> m <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). ICS <br /> 2. Show the location of the well (NI), septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions in feet of thefollowing:(a) building to all lot lines,(b)building to center line of road,(c)building -q <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 9 <br /> dated by the owner. O a <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1A o w <br /> PLOT PLANZ <br /> M o a <br /> M <br /> Ind � = <br /> 1 � <br /> o <br /> J <br /> N � <br /> O <br /> J <br /> J <br /> b <br /> O � <br /> m <br /> w <br /> Z <br /> z <br /> N <br /> G <br /> n <br /> m a m a a <br /> CONDITIONS OF PERMIT a mg : 0 o S �_ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG S�OREUNE. = »1 m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 8f a <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 informs- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 m 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- w <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 8 $ <br /> T m A F <br /> M aaz <br /> SIGN HERE ' <br /> (signs tur of o ner r buildin actor) (d i <br /> s : [ <br /> ZONING ADMINISTRATOR <br /> NSHIP PERMITS MAY BE REQUIRED N N o o$ m <br /> 888 88880 <br />