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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS0 <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 9— w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and r ,� <br /> regulations of the State of Wisconsin. v <br /> MIT ° <br /> OWNER T . TELEPHONE <br /> ADDRESS ®AtI <br /> EMERGENCY/FIRE NUMBER 11Q ROAD NAME <br /> BlL DY. <br /> v <br /> 11 <br /> LEGAL DESCRIPTION (see tax receipt) o � (T <br /> CONTRACTOR <br /> �v <br /> TYPE OF PERMIT(S): DWELLING/3UILDING ✓ GARAGE/ACCESSORY STRUCTURE ADDITION .- <br /> 05 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONI 0 <br /> Zj <br /> o � <br /> STRUCTURE/ADDITION USE: 443 l� <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) ZrI o <br /> of <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and siz( of all existing buildings (EB) and all new buildings (NS) and Indicate North (N). <br /> 2. Show the location of the w ell (Y),septic tank (ST), and drainfield (DIF). 0 <br /> 3. Show dimensions in feetofhefollowing:(a) buildingtoalllotlines,(b)buildingtocenterlineofroad,(c)building <br /> measurement to the ordinay high water mark of lake,stream,or river. 0 1 <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 0 <br /> NOTE: BUILDING/STRUCTURE L N <br /> TIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I v N <br /> 7I z `c <br /> PLOT PLAN Ln A ' <br /> 0 <br /> ar <br /> tJ <br /> C \ <br /> m J-v <br /> d l� <br /> /a i Jr o <br /> t �2 <br /> 0 J-11 <br /> ® Q tilt ' <br /> VI r MV V <br /> T � <br /> J Z <br /> a <br /> 0!f�rrt <br /> �rDia� m <br /> \ MI <br /> CONDITIONS OF PERMIT: v se <br /> 1. DRIVEWAY MUST MEET RIVEWAY Wt. HEOUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p 0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. CO 33 <br /> 3. NO GRADING OR SHOR LAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` P' L7 0 :o: m0 <br /> I declare that this application(ncluding any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,CorrMt and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- l iw y In <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. i i a p <br /> malion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability whit I may be a result of the County of Burnett relying on this information I am providing in this ap- d, x <br /> plication.Iagree to permit co my officials charged with administering county ordinances or other authorized mm.,to have i O N o <br /> access to the above describe( premises at any reasonable time for the purpose of inspection. .n ; 3 0 )'� <br /> SIGN HERE m,i E <br /> (a 5p u of owner r ud contractor, ( (da e) o <br /> x : ! <br /> ZONING ADMINISTRAT0 E f x <br /> TOWNSHIP PERMITS MAY BE REQUIRED o to m <br /> - 000 $ a, <br /> 0 <br />