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c,1 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d c a <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> TO THE 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 shall be done in accordance with the requirements of the cc <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and nm <br /> regulations of the State of Wisconsin. — o <br /> w m <br /> / w <br /> OWNER MI'CAae 9q V A ie TELEPHONE (IV 12 yja 2 — 1988 n £ <br /> ADDRESS 592 �� SSo �! O �m <br /> EMERGENCY/FIRE NUMBER ROAD NAME OC <br /> LEGAL DESCRIPTION (see tau receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> o <br /> SANITARYPRIW FILLING/GRADING CAMPING UNIT SUBDIVISION o` � m <br /> STRUCTURE/ADDITION USE: a o �— <br /> (Home/Cabin;Commercial Busi as;Bedroom;Deck;etc.) Z <br /> 0 0 <br /> c <br /> } <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 in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building -q <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 <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I 3 to <br /> PLOT PLAN z `o <br /> fn � <br /> I <br /> N <br /> O <br /> N <br /> m <br /> o <br /> N_ <br /> n <br /> y^� Z <br /> / V y <br /> I <br /> �. <br /> o2. m m a m a <br /> CONDITIONS OF PERMIT: a m c m o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F ? T 0 o i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 4i » _ m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m c <br /> g : o <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o i 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 informs- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 75 R ro <br /> m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g $ <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 Oo <br /> access to the above described premises at an reasonable time for the purpose of inspection. 8 9 <br /> T <br /> M m <br /> W <br /> SIGN MERE <br /> (signature of owner o din ntr (daI ) <br /> ZONING ADMINISTRATOR <br /> TOWN PERMITS MAY BE REQUIRED <br /> ,r"n . ornooi� m <br />