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Ic <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratora o <br /> APPLICATION FOR — LAND USE — PERMITS3. — <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w O <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 Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. y m <br /> m <br /> C O <br /> OWNER TELEPHONE —� n <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME / �'tY LO 261 X. <br /> see tax recei <br /> ( p)LEGAL DESCRIPTION receipt) w. LLL I r� W CCC���--- V <br /> Y Qne- ha !-� �f -l-h�e k . /z of SW rrF Sr, <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING O GARAGE/ACCESSORY STRUCTURE_ ADDITION p <br /> �ASANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a <br /> STRUCTURE/ADDITION USE: l�7--P: <br /> 0 2 <br /> (Home/Cabin;Com cial Business; Bedroom; Deck; etc.) Z v f <br /> O o <br /> v <br /> m <br /> D <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). o <br /> 3. Show dimensions In feet of thefollowing:(a) building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordinary high water mark of lake, stream, or river. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. <br /> 00 <br /> NOTE: BUILDING/STRUCTURE.LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I 3 W <br /> PLOT PLANI <br /> to PCet <br /> o _ <br /> i fn t <br /> 1 <br /> N <br /> V <br /> o p � <br /> a <br /> Zo>2- o <br /> a <br /> I f l I n <br /> I � <br /> i <br /> a ke 26 <br /> chia :E <br /> T. 33g� = a0Qm mM <br /> CONDITIONS OF PERMIT: Q is <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c E 5 `Z : -i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =y1 M <br /> 5, <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. : o . 0 : r <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 informs- n: In <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- o ; p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 o <br /> further accept all liability which may be a result of the Count urnett relying on this information I 4mprolviding in this ap- <br /> plication. I agree to permit county officials charged with iniste ing county ordinances or other airtho 'zed person to have m <br /> access to the abo ascribed premises at any reasons time r the purpose of inspection. <br /> T <br /> 0 <br /> SIGN HERE <br /> (signatu nar u' g tor) (d at ) },, <br /> ZONING ADMINISTRATOR <br /> OWNSHIP PERMITS MAY BE REQUIRED U' N N W N N N N m <br /> O N N U N n m <br /> 0000 9o $ 000 fit <br />