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Office of Zoning Administrator m <br /> Burnett Cognty 7410 Co. Rd� K, No. 102, Siren, WI SU72 d 3 a <br /> APPLIC TION FOR — LAND USE — PERMITS y <br /> TO THE�JNING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the a <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. m <br /> // i TELEPHONE c O <br /> OWNER I�/!I(.i, I/VL L) U (/ I C.- . Z AJ / / ) o m <br /> C <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER C ( ROAD NAME ' ,,u A I f t:' <br /> LEGAL DESCRIPTION (see tax receipt) <br /> J <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/B ILDING GARAGE/ACCESSORY STRUCTURE ADDITION O <br /> C) <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> � o ° <br /> STRUCTURE/ADDITION USE: 'a , <br /> Home/Cabin;Commercial Business; Bedroom;Deck;etc-) o 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size f all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> 2. Show the location of thew II (W),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions infeet oft efollowing:(a)buildingto all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordinarl 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 <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE L TIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I o C <br /> 11 Z Q <br /> .0 9 I <br /> PLOT PLAN A `- <br /> Aler� <br /> �w '�/� SgNf7R <br /> � N <br /> n_ <br /> (�I o <br /> 0 <br /> O II <br /> b <br /> O I�11`y <br /> Z <br /> \ `III lr <br /> I <br /> c r D a 0 <br /> X � fm <br /> n 2 a m <br /> 0 b305, Q C S .00= <br /> CONDITIONS OF PERMIT: o 5 : % "I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. N n m <br /> 3. NO GRADING OR SHOR LAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 0 : o. : . C <br /> 1 declare that this application including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- v <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- c <br /> o ® : <br /> mation I am providing will be <br /> relied upon by the County of Burnett Wisconsin in determining whether to issue s pthis a. I - <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- O a o <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have . m o m <br /> access to the above describedpremises at any reasonable time for the purpose of inspection. T ; 3 0 R.Ee'+ <br /> SIGN HERE (date) ? ra' FFFlll <br /> ( ignature of n ( <br /> or building contractor) <br /> Fc3 <br /> ZONING ADMINISTRATORd.fy N N rt1 <br /> TOWNSHIP PERMITS MAY BE REOUIRED 5 <br /> C800 8,$f0mgu) <br /> 0 <br />