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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 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 n <br /> regulations of the State of Wisconsin. — o <br /> N m <br /> (n � )erroC°1 <br /> N- <br /> TELEPHONE <br /> OOWNER G7 / � <br /> ADDRESS p! ^ m <br /> EMERGENCY/FIRE NUMBER S ROAD NAME 11` <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR , <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNITn O <br /> SUBDIVISION a o <br /> STRUCTURE/ADDITION USE: yx� o 0 <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) -"% <br /> 2 0 <br /> 0 0 <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). o <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)building 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 2 <br /> dated by the owner. O O <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. v <br /> N <br /> PLOT PLAN 1A z cc <br /> o a <br /> m 0 <br /> C 1 <br /> Set° �I Ila���/f��^ <br /> a <br /> m <br /> ~P fees f -Z� <br /> Q« l" v, �,� � ll" - c <br /> M <br /> M <br /> QYt ,....� ice )tis I i✓rou�eP S� I:r <br /> Yl'w C`Z'{ 91 <br /> .O vlm„�Q Q Moll <br /> m o C ro mr n p g <br /> CONDITIONS OF PERMIT <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E ? -9 z -4 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 21N m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. i V 62 iO <br /> g : c : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m m ' 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- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation t am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 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- <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O N <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> T A <br /> M O A N <br /> M <br /> SIGN HERE <br /> m <br /> (sto of owner ilding contractor) (date) <br /> o : <br /> ZONING ADMINISTRATOR L 8 <br /> H �-wwwv. T <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 8888888 $ n <br />