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Mc - iP <br /> Burnett-County 741p Co. !Ad—K, lto. 102, Siren, Will 54872 Office of Zoning Administrator d m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> m o <br /> TO THE ZONING ADMINISTRA OR:The undersigned hereby makes application for a Permit for the work described and mc <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the C <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. - <br /> w d <br /> w � <br /> OWNER TELEPHONE >' n <br /> ?(5 6S'7 - �3-, ? <br /> a <br /> w <br /> ADDRESSVsV <br /> -�� `—° <br /> So I <br /> EMERGENCY/FIRE NUMBER ROAD NAME v —= W <br /> LEGAL DESCRIPTION (see tax re�eipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING BUILDING j. GARAGE/ACCESSORY STRUCTURE_X ADDITION <br /> (` <br /> SANITARY PRIVY o FILLING/GRADING CAMPING UNIT SUBDIVISION o ` 1WI <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;et�.v Z o <br /> 0 0 <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). <br /> 3. Show dimensions infeet ofthefollowing:(a) building to all lot lines,(b)building to center line of road,(c)building 14 <br /> measurement to the ordinary high water mark of lake, stream, or river. <br /> 4. If separate plans are subm tted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. LL� 0 a <br /> NOTE: BUILDING/STRUCTURE LO¢;ATIONS MUST BE STAKED FOR ONSfTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a m <br /> PLOT PLAN o a <br /> A <br /> fn o <br /> C <br /> See <br /> chemo for PLA m <br /> o <br /> _ <br /> m <br /> � N <br /> Uj <br /> O_ c N tDi C F M <br /> m M�� 6aw rm 3l <br /> CONDITIONS OF PERMIT: v m. C 6 S <br /> 1. DRIVEWAY MUST MEET I RIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F `z <br /> 2. REMOVAL OR CUTTING F TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N <br /> 3. NO GRADING OR SHORE-AND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Ti 6 2 : m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl o C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- �^m�" m <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 elied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ <br /> further accept all liability whit 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 cou ity officials charged with administering county ordinances or other authorized person to have O <br /> access to the above described premises at any reasonable time for the purpose of inspection. w <br /> N m w <br /> SIGN HERE <br /> (signature eowner or riding contractorl (date) i <br /> N? <br /> ZONING ADMINISTRATOR J I mcZ/1 tGlc�/1 <br /> OnTOWNSHIP PERMITS MAY BE REQUIRED oN N N <br /> $ $ $ 'o <br />