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Sums" County 7A10 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m -4 0 <br /> APPLICATION FOR - LAND USE - PERMITS . <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes Q ° <br /> located as shown herein. The undersigned application for r Permit for the work described and 9 w 4 <br /> g 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 <br /> regulations of the State of Wisconsin. a m <br /> b � <br /> C <br /> OWNER "13RULE r�Jp�Cct'IA TELEPHONE '�IS- �66 - �q(o(o m � <br /> ADDRESS 77Il FRt'r1sTEgD ►"?o• DgNBURT� WI • �`�830 <br /> i <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> "S <br /> LEGAL DESCRIPTION (seet"receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION Q <br /> n o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> J <br /> w <br /> STRUCTURE/ADDITION USE: o 2 <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z <br /> o ° <br /> 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 dralnfield (DF). k 5 <br /> 3. Show dimensions in feet ofthefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building O� <br /> measurement to the ordinary high water mark of lake,stream,or river. 0� <br /> 4. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 111 o y <br /> c <br /> PLOT PLAN o o • <br /> � 3 _ <br /> IT1 y <br /> O j <br /> + o m � <br /> U� <br /> s <br /> I o, <br /> � 1x <br /> 0 <br /> s �. <br /> O y <br /> N <br /> Z <br /> m <br /> CONDITIONS OF PERMIT: o g g C8 NO g ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E Iit <br /> Q i ; =12. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. N' 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r" i ` ti ? In <br /> 1i of g : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- p„ oi <br /> ' ; C33edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- «m •�i m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- i B <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 $� $ <br /> further accept all liability which may be a result of the County of Sumett 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 <br /> access to the above described premises at any reasonable time for the purpose of inspection. �'• <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) « <br /> ZONING ADMINISTRATOR `11rT1 Y 1 8 E <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> gyp .« ««.,� -n4) � 4X� m <br /> ��88 $ $ 88 ai <br />