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) <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m c o <br /> APPLICATION FOR — LAND USE — PERMITS d 3. <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 '^ 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. N <br /> m <br /> OWNER nn C n O <br /> /JG a ti P ✓ 7P lC(y(/�t'{ TELEPHONE O <br /> ADDRESS Q1 2 2,2 q Hle 1, ei ( A/. Gree-o f, Lkj k1j <br /> EMERGENCY/FIRE NUMBER 3Al ) ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR 57 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGElACCESSORY STRUCTURE ADDITION p <br /> o <br /> SANITARY—,--,, PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o0 <br /> STRUCTURE/ADDITION USE: � ON <br /> (Home/Cabin;Commercial Busine ,Bedroom;D k;etc.) Z <br /> 0 0 <br /> a <br /> m <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). 0 <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. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 2 <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a VJ <br /> c <br /> PLOT PLAN A o 'n <br /> M <br /> u�) <br /> 7V y <br /> A <br /> O <br /> O <br /> O <br /> vl <br /> b <br /> O � <br /> H <br /> Z <br /> Z <br /> Do c <m m � a F mo <br /> or <br /> M. y a`� m a m Il <br /> CONDITIONS OF PERMIT: ? n < x S o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o <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. � m n 0 <br /> $ c : <br /> a � <br /> 1 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 informs. w m Fn O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I 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. w <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized parson to have O N p <br /> access to the above described premises at any reasonable time for the purpose of inspection. 1 m 8 9 <br /> T i 9 A a i <br /> N A A <br /> SIGN HERE <br /> a ? : <br /> (signaldFe of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR 1 11Y1 �c�lriTa-C\ <br /> TOWNSHIP PERMITS MAY BE REOUIREDN - <br /> H HH6i T <br /> utut . aoo � m <br /> 99 $ $ $ $ tmn <br />