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(/��/J` <br /> Buynett C6unty,7410 Co. Rd. K. No. 102, Siren,WI 54872 Office of Zoning Administrator 00 o <br /> APPLICATION FOR — LAND USE — PERMITS m o <br /> TO THE ZONING ADMINISTRAT R:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The ur clersigned agrees that all work shall be done in accordance with the requirements of the $ <br /> Burnett County Land Use Ordina ice,Sanitation Code,and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State of Wisco isin. w m <br /> c g <br /> $ O <br /> OWNERDebb(e Haley TELEPHONE 17751349-5593 m - <br /> 0 <br /> ADDRESS 24779 County oad N Web�sten W1 54893 <br /> EMERGENCY/FIRE NUMBER2 179 ROAD NAME COunty Road NI <br /> LEGAL DESCRIPTION (see taxrec ipq Ct. NE Ni Section 4. 13811 R17W. Town o4 Danief-A <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n 0 <br /> SANITARY x PRIVY FILLING/GRADING CAMPING UNITSUBDIVISION ° <br /> o < <br /> w � <br /> STRUCTURE/ADDITION USE: SanitaA Una ° g <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z o <br /> 0 c <br /> m <br /> } <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) Lp <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 thew II (W),septic tank (ST),and dralnfleld (DF). 4 <br /> 3. Show dimensions In feet ollhe following:(a)building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordini 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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. <br /> Z o <br /> PLOT PLAN <br /> M ° <br /> C <br /> G <br /> l <br /> 0 <br /> 1 <br /> 0 <br /> I° <br /> SEE ATTACHED <br /> z <br /> n <br /> cJ <br /> so 9 <br /> A� m <br /> CONDITIONS OF PERMIT: a r� '� '� 8 8 ; <br /> 1. DRIVEWAY MUST MEET RIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p 2i i :?I <br /> 2. REMOVAL OR CUTTING F TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. a <br /> 3. NO GRADING OR SHOR LAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r^ n i 0 <br /> 1i i lei : C <br /> I declare that this application including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,c0i t and complete.I acknowledge that I am responsible for the detail and accuracy Of all informs- m <br /> tion contained in this app)icat on(including any accompanying schedule)and I further declare that I recognize that this Infor. p <br /> motion I am providing will be rolled upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 ; 81 8 ; <br /> further accept all)lability whic It may be a result of the County of Burnett relying on this information I am providing In this so- <br /> pllcatlon.1agree to permit coi my officials charged with administering county ordinencse or other authorized person to have <br /> access to the above describe promises at any reasonable time for the purpose of Inspection. ,n s <br /> M <br /> SIGN HERE <br /> ( ignsturs of owner or building contractor) <br /> ZONING ADMINISTRATOR f ` i 8 <br /> TOWNSHIP PERMITS MAY BE REOUIR 2 S '13 in <br /> m <br /> 888888i8I8 U) <br />