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e , <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d ; a o <br /> APPLICATION FOR - LAND USE - PERMITS3 <br /> m C <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q Z <br /> n c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme sof the <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. rn d <br /> / n O <br /> OWNER � TELEPHONE -" E <br /> 1 f m `: <br /> ADDRES v VO <br /> EMERGENCY/FIRE NUMBER fs/1�L ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) Naw — tsL10 / !"— <br /> CONTRACTOR e-) <br /> � <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 1, <br /> STRUCTURE/ADDITION USE: I I /1 / Its ( o (� <br /> (Home/Cabi ommercial Business; Bedroom;Deck;etc.) Z o <br /> 0 0 <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). �) <br /> 2. Show the location of the well (W),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,(c)building p <br /> measurement to the ordinary high water mark of lake, stream, or river. Q <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be s ned and A <br /> dated by the owner. 0 o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. an o m <br /> �I Z c <br /> PLOT PLAN � c, � I, <br /> DD <br /> is' m <br /> - <br /> rn <br /> - r` o <br /> y o I <br /> 0 <br /> b <br /> �' Droyo'1-Gr p ti <br /> 1 �p ry <br /> Z <br /> yt Vv <br /> f <br /> T N <br /> / 7�— 'M 00 af 'D <br /> v o _$� � am a0M <br /> M 2 m <br /> CONDITIONS OF PERMIT: ^ < Z as =05 <br /> T+ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f 0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =y M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. U. mi O o tC i In <br /> PP (including Yaccompanying 1 Y y w m' <br /> I declare roar this application includin an schedule has been examined b me and to the best o m knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- '^w`° T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 2A ; 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 I am providin in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized pe i 00 o <br /> access to the above described premises at any reasonable time for the purpose of inspection. i 3 $ 3(- <br /> Q : ' <br /> p N <br /> SIGN HERE �a"r^-` <br /> (sip ur of owner buil g contractor) (date) ro <br /> o � <br /> ZONING ADMINISTRATOR ♦ «; k k <br /> TOWNSHIP PERMIT AY BE REOUIRED N ro N m <br /> $ $ $ a$ $ $ ® V1 <br /> w <br /> X x x <br /> CD <br /> 0 <br />