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AI Com, <br /> Burnett County 110 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS3, <br /> m C <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v <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 <br /> regulations of the State of Wisconsin. H m <br /> w m <br /> O <br /> OWNER TELEPHONE E <br /> o ' <br /> ADDRESS o <br /> EMERGENCY/FIRE NUMBER 3'�� o/ ROAD NAME ��w� 5t 6 <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR \C <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE 666 ADDITION O q <br /> n 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o a ` <br /> J ` I J <br /> STRUCTURE/ADDITION USE: c� F1 )\y �I - o <br /> (Home/Cabin;Commercial Business Bedroom; Deck;etc.) Z o <br /> o c <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). g <br /> 3. Show dimensions in feet of the following:(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 sigged and <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 v N <br /> PLOT PLAN Z c <br /> C � a I� <br /> V1 J <br /> a y._ <br /> I <br /> N <br /> olcheoC <br /> m <br /> O <br /> J <br /> ,I <br /> m <br /> o <br /> Z <br /> f <br /> WIU DDOM <br /> 9 X'� J.� �8 $F m <br /> o DSS '-2.a0 m M <br /> CONDITIONS OF PERMIT: ' <,w'iQ g ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. : =N ' Of <br /> Of <br /> N. E pp <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. .,'J? <br /> Er D <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of limy knowb <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- : $ B p <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 <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, other authorized peroion to hive ; 0: O <br /> access to the above described premises at any reasonable time for the purpose of inspection. : m <br /> w <br /> r /q/q ry kyr <br /> SIGN HER ,- <br /> date ` <br /> (signature -of owner or buiidl contractor) ( 1 <br /> ZONING ADMINISTRATOR J <br /> N N N N N« In <br /> TOWNSHIP PERMIT MAY BE REOUIRED ;r p N N$ m <br /> 88'$ 8888rmn <br />