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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator o <br /> 10 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> m O <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and i <br /> located as`shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the e m <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, <br /> w m <br /> OWNER r NTELEPHONE SG " 1370 <br /> o. £ot.✓ nrd `� /�Hke 9 cN G <br /> ADDRESS G y a 3 <br /> EMERGENCY/FIRE NUMBER G 3 ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> 1 <br /> CONTRACTOR <br /> O <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> � L7 <br /> SANITARY PRIVY FILLING/GRADING <br /> CAMPING UNIT SUBDIVISION o ° C. <br /> STRUCTURE/ADDITION USE: (] 7,- e' <br /> (Home/Cabin;Commercial Business;Bedroom; ck;etc.) Z v <br /> 0 0 <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) W ` <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 in feet ofthefollowing:(a) buildingto all lot lines,(b)buiidingto center line of road,(c)building <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. 0 0 <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a w <br /> PLOT PLAN A o a <br /> M a <br /> c 3Z <br /> a <br /> 0 <br /> l <br /> 0 <br /> 4 m <br /> m <br /> n o <br /> I <br /> fi <br /> N y Q <br /> O <br /> 0 <br /> 0 <br /> b <br /> I <br /> m <br /> a <br /> I` <br /> Z <br /> n _ <br /> b <br /> W lA T (D r D D p U <br /> r�NDITIONS OF PERMIT: m. : Z C . 0 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F T� a <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. = 2 m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED.' : » : C <br /> g : c <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o 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- m O <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I m <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 a <br /> access to the above described premises at any reasonable time for the purpose of inspection. . m .8 <br /> m 3 <br /> tOD i Em A m i <br /> 7 - 3,1 92- » : � s . <br /> SIGN HERE m <br /> (signature o> owner or buildingntr�or) (date) <br /> ZONING ADMINISTRATOR �In�i✓1-r/nl,(n.pn� 8 E <br /> H : <br /> TOWNSHIP PERMITS MAY BE REQUIRED » N 0 0 N H H» rn <br />