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N cMAP <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator Um -. a <br /> '-. <br /> APPLICATION FOR — LAND USE — PERMITS m TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the S <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 /> m <br /> m � <br /> c <br /> OWNER TELEPHONE <br /> ADDRESS g <br /> EMERGENCY/FIRE NUMBER ` ROAD NA ? <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE_ _ ADDITIONJ C�i o <br /> � Gt <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIV/I/SION-gfo ° <br /> STRUCTURE/ADDITION USE: xe��� l-ILi�I'YlOfl 71) Ca� � �f' �--Qco rnPy bA LIIJ o <br /> (Home/Cabin;Commercialbusiness;Bed om; D44;etc.) Z o <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 drainfteld (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 <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 <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. 0 0 r <br /> NOTE: BUILDINC/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a N V) <br /> 1A `v Ilv <br /> PLOT PLANZ <br /> �ZHI�� I2 vy Cll�/ lU�J— S�/�� < <br /> S� f r <br /> �� H <br /> CUj` <br /> fn , <br /> n a o <br /> to C, <br /> O Il�yll J, <br /> m <br /> ra7-� o <br /> kc� <br /> Ih <br /> Z <br /> h /I <br /> N_vf( (� <br /> CONDITIONS OF PERMIT: CZONGOSHORELINE. <br /> (J^ o m g .z I g� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60F PE MIT ISSUA 0 M <br /> E. Z o ': `�.Z <br /> o E _ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED tg� 33 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r"i '• t5 m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of 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 informa- - « �-+- p <br /> m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- is <br /> S <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 in this ap- E i ' <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of Inspection. 9 ': <br /> gw : <br /> SIGN HERE �'j '• «� B <br /> (signature of owner or b Ing contr t •'_ \ <br /> ZONING ADMINISTRATOR 8 E <br /> TOWNSHIP PERMIT MAY BE REQUIRED it. o in m <br /> �88888888fmn <br />