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so <br /> Burnett Counhir 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m IE <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINIST TOR:The undersigned hereby makes application for a Permit for the work described and 0 <br /> c <br /> located as shown herein. T undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Or Jinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of W sconsin. H m <br /> m m^ <br /> OWNER TELEPHONE a <br /> F <br /> o m <br /> m_ <br /> ADDRESS 10 /1/O/1- <br /> EMERGENCY/FIRE NUMBER v� S-eel <br /> ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR 1 ;r 1. ' 'L) <br /> TYPE OF PERMIT(S): DWELLING/BUILDING 7 GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo 0 <br /> J <br /> STRUCTURE/ADDITION USE: 7 PTLD r1'Lr� U <br /> (Home/Cabin;Commercial Business, Bedroom; Deck;eta) Z <br /> o <br /> a <br /> m <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 dreinfield (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 ord nary high water mark of lake,stream, or river. G <br /> 4. If separate plans are sut imifted by an architect,engineer,builder,contractor,etc.,the plans must be signed and A <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE OCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. low 3 m <br /> PLOT PLAN /� ) Z S <br /> L O jaJ1 ltc , r �Ola."/ n o 'a <br /> sC/� <br /> fn DQ o <br /> rl <br /> LT) � <br /> / O <br /> e <br /> 00 <br /> o <br /> Z <br /> 2 O c N r 0 a <br /> MO amm cm9 <br /> CONDITIO SOF PERMIT: <br /> 1. DRIVEW Y MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 5 ' --Q ' <br /> 2. REMOVAL OR CUTTINO OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =r» 9 <br /> 3. NO GRADING OR SH RELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. !" O o � m <br /> 0 : ° <br /> I declare that this applicatioi(including any accompanying schedule)has been examined by me and to the best of my knowl- '�',t o m ! C <br /> edge and belief it is true,cc rect and complete.1 acknowledge that I am responsible for the detail and accuracy of all informa- 0. : a w m <br /> tion contained in this applic tion(including any accompanying schedule)and I further declare that I recognize that this infor- Q is ; p <br /> mation 1 am providing will a relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I C�: g`� <br /> further accept all liability w ich may be a result of the County of Burnett relying on this information I am providing in this ap- x <br /> plication. I agree to permit ounty officials charged with administering county ordinances or other authorized person to have i w N p <br /> access to the above des premises at any onable ti for he purpose of inspection. <br /> m : 3 <br /> SIGN HERE <br /> u : <br /> (ai a of owner o Id)AQ c' tractort (date) Oi <br /> [ O <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED o N m <br /> booo m <br /> 000 0 fA <br /> w <br /> I o <br />