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Vrr a-qy/ <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren. WI 54872 Office of Zoning Administrator m% m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work desc ibed and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of 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, <br /> w m <br /> w m <br /> c <br /> OWNER TELEPHONE (�£ <br /> 1'1 O r• o <br /> ADDRESS 2 1S MD►J f?D . A` 414 O. JPO(PO <br /> EMERGENCY/FIRE NUMBER ROAD NAME >� <br /> Q <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR (__1 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> L7 V Imo" <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION0 <br /> O 'Cn <br /> n ' .a loSTRUCTURE/ADDITION USE: ? a r G <br /> (Home/Cabin ommercial Business; Bedrilg ;Deck;etc.) Z v <br /> 0 0 <br /> c` v <br /> w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) W ` <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 dralnfield (DF). <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(cl 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. O <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on 3 rn <br /> PLOT PLAN A o a <br /> O ` <br /> 0 <br /> O <br /> Ca <br /> M _n <br /> O <br /> L � <br /> 8 0 <br /> O y <br /> a ^ <br /> vv �J <br /> Z <br /> S <br /> W <br /> �� m <br /> o g4 ae 31 <br /> CONDITIONS OF PERMIT: = 3:; ,� c g'42 Z <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. � ^U„ m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. k <br /> EB '' ` O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best o my 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- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize ths t this infor- L�: : $d O <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue is permit. 1 8 <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- i I ' <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized per n to have p <br /> access to the above described premises at any reasonable time for the purpose of inspection. 9 <br /> -n 0 <br /> SIGN MERE ZD « «.. <br /> (date) <br /> ZONING ADMINISTRATOR '• g '• <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N to in d m <br /> 888888 y <br />