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Burnett County 7410 Co. R . K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o a <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> ° J <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � w <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 n 3 <br /> regulations of the State of Wisco sin. y m <br /> m m <br /> f n O <br /> OWNER Crdl K�1L( I(J - TELEPHONE o <br /> v � <br /> ADDRESSUrCJ2 R .� <br /> EMERGENCY/FIRE NUMBER ROAD NAME I� <br /> I t <br /> C <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/ UILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> n o0 <br /> SANITARY PRIVY_ FILLING/GRADING CAMPING UNIT SUBDIVISION� ? <br /> 0 <br /> STRUCTURE/ADDITION USE: Z <br /> Home/Cabin;Commercial Business; Bedroom; Deck; etc.) 0 v <br /> 0 <br /> 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 drainfield (D17. <br /> 3. Show dimensions infeet oft efollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)building -4 <br /> measurement to the ordinary high water mark of lake,stream,or river. Q <br /> 4. If separate plans are submit ed by an architect,engineer,builder,contractor,etc.,the plans must be signed and - <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOakTIONS MUST BE STAKED FOR ONSffE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I v <br /> 71 z c <br /> PLOT PLAN o n <br /> fn o <br /> et <br /> I = <br /> � C n <br /> � 0 <br /> 0 <br /> � o <br /> O � <br /> Z <br /> I D <br /> G <br /> raaf m <br /> XI <br /> CONDITIONS OF PERMIT: a' y,_ Q CS -0 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 3 � ' <br /> 2. REMOVAL OR CUTTING CF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =Q' <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. I i O n m <br /> ig <br /> C <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,corr and complete.I acknowledge that I am responsible for the detail and accuracy of all informs . d.m T; In <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 8 iiia : p <br /> mation 1 am providing will be lied upon by the County of Burnett Wisconsin in determining whether to issue apermit. I o o <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- y, <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have O N p <br /> access to the above described premises at any reasonable time for the purpose of inspection. 0 <br /> A N <br /> M O <br /> SIGN HERE r"i .8 <br /> (alnature of ownpr or build'ng contractor) (date) <br /> ZONING ADMINISTRATOR " �'� 0 , <br /> TOWNSHIP PERMITS BE REOUIRED 'o N N U U" 8 8In <br /> 00000000 (a <br />