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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> 'APPLICATION FOR — LAND USE — PERMITS3. <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and c o <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the C <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. o <br /> � m <br /> m v <br /> C <br /> OWNER RICNgRn I/ I✓�,y�/t, / TELEPHONE 11 ti 3K- <br /> ADDRESS <br /> 'j ADDRESS (00 MDu�JOS '[ LVD 5T• FRUL. i miij 55 IoG <br /> EMERGENCY/FIRE NUMBER �1�] � Oil /n ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) J? <br /> I J?��`K��� <br /> CONTRACTOR <br /> I <br /> TYPE OF PERMIT(S). DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> 4— n o <br /> SANITARY PRIFILLING/GRADING iCAMP G UNIT SUBDdI ION o <br /> STRUCTURE/ADDITION USE: 0^1 / 6m(Home/Cabin;Cimercial Jm <br /> _ <br /> Business Bedroom;Deck;etc.) <br /> 0 <br /> o v <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 drainfield (DF). <br /> 3. Show dimensions infeet of the following:(a) building to all lot lines,(b)buildingto center line of road,(c)building 11 <br /> measurement to the ordinary high water mark of lake,stream, or river. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. o <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a N <br /> PLOT PLAN o n <br /> m 4 <br /> R1fi� F� C <br /> ( G <br /> O � . <br /> m <br /> 0 <br /> J <br /> N <br /> O <br /> J <br /> J <br /> b <br /> N <br /> r <br /> 2 <br /> S <br /> C <br /> W D D p <br /> m o c m m o a <br /> m �D Jm Ja o a m m H 5 a <br /> CONDITIONS OF PERMIT. $ N. 'm2m o = m 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 5 T12 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - r» m <br /> 3, NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> m ° C <br /> g : 3 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m `� m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa. w m <br /> tion contained in this application(including an accompanyingschedule and I further declare that 1 recognize that this infor- <br /> mation <br /> m N <br /> Pp ( 9 Y 1 g <br /> I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I8 m 8 <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- . '` w <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have U1 O <br /> access to the above described premises at any reasonable time for the purpose of inspection. 4 m 8 R <br /> m a n H <br /> SIGN HERE-1 <br /> m : <br /> a : : <br /> (signature of o r ti ' m ntractor) date) ' <br /> ZONING ADMINISTRATOR <br /> TO SHIP PERMITS MAY BE REOUIR Q, a`N N o o m <br /> — <br /> 888 8888rmn <br />