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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator (DJo <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> d <br /> 70 THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and U; 0 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the M C n <br /> Burnett County Land Use Ordinance,Sanitation Cade,and with all other applicable County Ordinances and the laws and _ a <br /> regulations of the State of Wisconsin. H o <br /> _ N � <br /> OWNER Jj,. TELEPHONE a j FO <br /> / y <br /> ADDRESS 7 �4 ✓ 14"01 <br /> � <br /> EMERGENCY/FIRE NUMBER �,/ 5 44 ROAD NAME 1df <br /> IM <br /> LEGAL DESCRIPTION (seetaxreceipt) f ,r./� S 30 7 ,? % f <br /> /I <br /> CONTRACTOR <br /> "P;A/e /)e-�, 7� IOU <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION IN p <br /> SANITARY o <br /> __�PRIW FILLING/GRADING CAMPING UNIT SUBDIVISION o` 0 <br /> ^ r <br /> STRUCTURE/ADDITION USE: o a <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> 0 0 <br /> v <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 in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building lyt, <br /> measurement to the ordinary high water mark of lake,stream, or river. IINI <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. 0 a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. <br /> PLOT PLAN Z <br /> o a <br /> m � o <br /> ,y c U, <br /> F1 <br /> 0 <br /> o <br /> 0 <br /> m <br /> o <br /> �xJ <br /> Z <br /> S <br /> IN IIIA VI <br /> I <br /> o o <br /> CONDITIONS OF PERMIT: <br /> v 0 R 0 c o o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F r1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m 0 C <br /> g i i <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- a <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 8 m 8 <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 or other authorized person to have O p <br /> access to the <br /> above described premises at any reasonable time for the purpose of inspection. / m 8 R <br /> SIGN HERE /Y-a-Zl r/`c "/- f.:r"�}✓JL.._ _. —_ . 11.-y. <br /> (signature of owner or building contractor) : ate) n ' <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REOUIRED m <br /> ��� 88 8888x, <br /> I I <br />