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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator eco l e o 0 <br /> 5 1 <br /> APPLICATION FOR — LAND USE — PERMITS a <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v a <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 _ <br /> regulations of the State of Wisconsin. , m <br /> c <br /> OWNER�W i a(mITELEPHONE �Jp�- C�63-- / C E <br /> ADDRESS O . n f(' II(�v1 a/LJ <br /> EMERGENCY/FIRE NUMBER � 4'' ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> OO <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> � t7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo 0 <br /> 0 <br /> pecSTRUCTURE/ADDITION USE: <br /> K Lv �PeneGazed <br /> (Home/Cabin;C mmercial business;Bedroom; De k;et e Z <br /> 0 0 <br /> v <br /> A <br /> 3 <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). <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. N separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1A o to <br /> PLOT PLAN * g <br /> f� o <br /> a ' <br /> 0 <br /> m <br /> O ti <br /> m <br /> I <br /> 2 <br /> S <br /> f <br /> O O A <br /> a <br /> CONDITIONS OF PERMIT: <br /> I. 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. E E >7 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` �' i `• O G <br /> I 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 informs- ri m <br /> tion contained in this application(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. 1 ; 81 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing Inthis ap• i i ' <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 promises at any reasonable time for the purpose of Inspection. T <br /> SIGN HERE �ep <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMjffS MAY BE REQUIRED o 1l57R7' 1I§ m <br /> 888888;88 w <br />