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Office of Zoning Administrator w m o 0 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 3 <br /> APPLICATION FOR — LAND USE — PERMITS z w o J <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 3 <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and = o <br /> regulations of the State of Wisconsin. ^ m <br /> m <br /> o <br /> m <br /> OWNER `(SS TELEPHONE <br /> INMBER <br /> L <br /> ADDRESS <br /> r, eEMERGENCY/FIR3�t)J ROAD NA/ME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> 7 <br /> CONTRACTOR <br /> TYPE OF FERMI IS): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> n O <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION m <br /> o = <br /> STRUCTURE/ADDITION USE: r-.leC.fM m <br /> Z <br /> (Home/Cabin;Commercial Business;Bedroom; k;etc.) o <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). 3. <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)bullding 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 O o <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. = n <br /> 0 <br /> PLOT P , C --h o I� <br /> 00 = 11 <br /> sv <br /> re <br /> L_ Q <br /> r � � <br /> V'k m <br /> o <br /> m <br /> 7 JO i <br /> Z <br /> /�1'1y <br /> /of A-49? 4 <br /> VV�ir lw � m r U)-0 a� M <br /> m <br /> 1 a O , r <br /> CONDITIONS OF PERMIT: o o : -4 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> IONIS RESTRICTED <br /> SHORELINE. <br /> 2. REMOVAL OR CUTTING OF TREES AND LOWED UNLESS SPECIFICALLY <br /> ITTED. - in O . <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE <br /> IF <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> knowl- GJ 0 : . <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- a C <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 <br /> 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- en" <br /> officials charged with administering county ordinances or other authorized person to have a0 <br /> plication.I agree to permit county <br /> access to the above described premises at any reasonable time for the purpose of inspection. vT 3 <br /> ' N <br /> SIGN HERE ( at re of owner o bu' Ing contractor) (date) <br /> rA [ [ <br /> ZONING ADMINISTRATOR " m <br /> SHIP PEMITS MAY BE REQUIRED n <br /> TOWNlo <br /> 0 <br /> 0 <br />