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Burnett Countq 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratorm o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 0 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR The undersigned hereby makes application for a Permit for the work described and H <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 Ordina ice,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wiscoi isin. H m <br /> N � <br /> c O <br /> 2Q�y 6 <br /> OWNER �' TELEPHONE <br /> C� <br /> J <br /> ADDRESS J !. \�I� C.D�-JI N . .&Sc) G <br /> EMERGENCY/FIRE NUMBER ROAD NAME 0 V CJ,t-1lt`)p 1\ <br /> LEGAL DESCRIPTION (see tax rece pt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/ UILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> oSANITARY _ PRIVY FILLING/GRADING CAMPING UNIT_ SUBDIVISION 0N <br /> STRUCTURE/ADDITION USE: ° o <br /> Home/Cabin;Commercial Business;Bedroom; Deck,etc.) Z o <br /> 0 0 <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 thew II (W),septic tank (ST), and drainfieid (DF). <br /> 3. Show dimensions in feet oft efollowing:(a) building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordinarif high water mark of lake,stream, or river. C <br /> 4. If separate plans are submi ed by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LO TIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I o ur <br /> 71 Z Q <br /> PLOT PLAN ° <_: <br /> u <br /> n <br /> M <br /> o <br /> C <br /> I <br /> t <br /> 0 <br /> _\ yyy <br /> N X/ <br /> J <br /> O -r <br /> io <br /> C' Z <br /> m ii c 9 0 A a:E m <br /> A D�`GaO C � �. <br /> CONDITIONS OF PERMIT: <, C8 J <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 5 : �jZ c+*: <br /> 2. REMOVAL OR CUTTING CF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Q 'y =r)^r" <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O 2a' m <br /> io <br /> 8 ' mo : ' C <br /> 10 <br /> I declare that this application(i cluding any accompanying schedule)has been examined by me and to the best of my knowl- : o <br /> edge and belief it is true,correctand complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- <br /> tion contained in this applicati n(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation 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 to this ap- fn x <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have ON p <br /> access to the above described premises at any reasonable time for the purpose of inspection. r 3 0 <br /> mA N i" <br /> fyp Y <br /> SIGN HERE I � �-jd8fei : <br /> ZONING ADMINISTRATOR x - <br /> 1 8 : x <br /> TOWNSHIP PERMITS MAYBE REQUIRED i o a N m <br /> _�-- - 0000 o U) <br /> 0 <br />