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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator VN` �az <br /> 0 m o 0 <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 Q H <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. Z o <br /> m w <br /> w � <br /> c <br /> OWNER TELEPHONE <br /> �forr <br /> ADDRESS 2700 W ' CP-dM LKRD Wk- 5q3y m <br /> � <br /> EMERGENCY/FIRE NUMBER ROAD NAME t <br /> LEGAL DESCRIPTION (see tax receipt) <br /> _ 1 <br /> CONTRACTOR <br /> TYPE OF PE ): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n Ll <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o < <br /> m r <br /> STRUCTURE/ADDITION USE: o g <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Zo T <br /> 0 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) Q <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). pp <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (OF). 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 M <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on 3 N <br /> PLOT PLAN z <br /> m N <br /> 6 <br /> I <br /> m <br /> 0 <br /> o �� <br /> _ <br /> Iv \ <br /> 0 <br /> w <br /> n <br /> m <br /> to, (n r- a0 <br /> 2am 4mm <br /> CONDITIONS OF PERMIT: a m N;: ,IT <br /> 2 CS Z <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. — � <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. vii : 62 :: m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o': <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- r a <br /> O >7 <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 11 o o m <br /> is : m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $`$ O , <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 o <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> m t ao <br /> SIGN HERE <br /> D(signet a of owner or it nq act <br /> ZONING ADMINISTRATOR <br /> TOWNS P ERMITS MAY BE REQUIRE U N N N N 6 N m <br /> � I o 0o goo r/) <br />