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alyW <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o a <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> d O <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and c <br /> located as shown herein. The Indersigned agrees that all work shall be done in accordance with the requirements of the „ J <br /> Burnett County Land Use Ordir ance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisc 3nsin. y ,� <br /> w � <br /> OWNER IC ' ICA./ ` 0.�rc <br /> ELEPHONE 6 iqL. 1 n O <br /> m <br /> ADDRESS 140 __r <br /> EMERGENCY/FIRE NUMBER `A ROAD <br /> i <br /> LEGAL DESCRIPTION (see tax re eipt) <br /> , <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLIN BUILDING GARAGEIACCESSORY STRUCTURE ADDITION p O <br /> V O <br /> SANITARY PRIVY FILLING/GRADING_ CAMPING UNIT SUBDIVISION o <br /> —TT <br /> m r <br /> STRUCTURE/ADDITION USE: N t o ° <br /> (Home/Cabin;Commerci4 Business;Be room; Deck;etc.) Z <br /> o 0 <br /> DIRECTIONS FOR PLOT PLA N DRAWING: (Aerial or top view) ` <br /> 1. Show the location and siz of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> 2. Show the location of the v ell (W),septic tank (ST), and drainfield (OF). _ {� <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 ordini ry high water mark of lake,stream, or river. C <br /> 4. If separate plans are subm tted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE L TIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 'fl a <br /> PLOT PLAN n o n <br /> M o+ <br /> C 19 <br /> cls? m a: <br /> ,Ui r <br /> tl <br /> II <br /> p <br /> (a( I > 0 <br /> N f= <br /> II 7 <br /> v � <br /> r <br /> I <br /> X <br /> 1 <br /> F <br /> c>j l a m m <br /> _g� 2ay <br /> D_. e.—_ <br /> M <br /> CONDITIONS OF PERMIT: .Z c o �O ,o <br /> 1. DRIVEWAY MUST MEET RIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z E 5 Q '.a"�'n: -i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORE LAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o n m <br /> E : <br /> I declare that this application(ncluding any accompanying schedule)has been examined by me and to the best of my knowl o: i m C <br /> XI <br /> edge and belief it is true,corre t and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this applicati Dn(including any accompanying schedule)and I further declare that I recognize that this infor. <br /> mation 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- <br /> plication.I agree to permit County officials charged with administering county ordinances or other authorized person to have <br /> 0, 0: <br /> access to the above describe( premises at any reasonable time for the purpose of inspection. m 3 b <br /> I m N <br /> N <br /> FA <br /> SIGN HERE <br /> (a gnature of owner or building contractor) (date) <br /> x <br /> ZONING ADMINISTRATOR 8 <br /> d.atnw`nw T <br /> TOWNSHIP PERMITS MAY BE REQUIRED � v a m <br /> m <br /> 0 <br />