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cn* <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 3 f o <br /> APPLICATION FOR — LAND USE — PERMITS d = o <br /> TO IHE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and c <br /> located as shown herein. The undersigned agrees that all work shalt be done in accordance with the requirements of the 3 a <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and _ o <br /> regulations of the State of Wisconsin. 0 <br /> c <br /> O <br /> � \�. '1�� �3�-7(�II a f <br /> OWNER �nir'� TELEPHONE ^gyp m <br /> ADDRESS 11,3 �„�) RL` \ l� "_� J `/� <br /> �`� I <br /> EMERGENCY/FIRE 'NUMBER �r` � J ROAD NAME <br /> 1"'I r I IC' ,,��1//�� <br /> LEGAL DESCRIPTION (see tax receipt) ^ w <br /> CONTRACTOR - j (p bl <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> SANITARY PRIVY <br /> FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> m r <br /> o <br /> STRUCTURE/ADDITION USE: v <br /> (Home/Cabin{Commercial Business;Bedroom; Deck;etc.) 0 0 <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 and drainfield D <br /> (W),septic tank (ST), ( F)• <br /> 3. Show dimensions In feet of the following:(a)building tall lot lines,(b)building to center line of road,(c)building G <br /> measurement to the ordinary high water mark of lake, stream,or river. 0 <br /> o <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 0 <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. Z Q <br /> o n <br /> PLOT PLAN m n <br /> NILA� <br /> < <br /> I <br /> 8 <br /> rn <br /> 0 <br /> /v <br /> t <br /> bnCJ. D 2 <br /> C 0 o <br /> m <br /> m 33 a 2 ° <br /> o ` Zc� c <br /> CONDITIONS OF PERMIT: c 9 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. -N: <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. c : g <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- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor <br /> motion 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- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have ? 3 g <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> m $ : <br /> M � O <br /> SIGN HERE (date) <br /> (signature of owner or building contractor) S <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITSMAY BE REQUIRED o " <br />