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Ltrht 6& <br /> / <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator � m o' o <br /> APPLICATION FOR - LAND USE - PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � w S <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme s 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. w m <br /> OWNER �\ CtS OtwQ TELEPHONE n £ <br /> T� O = <br /> ADDRESS ,^ C <br /> 1 <br /> EMERGENCY/FIRE NUMBER d\—)sCrb ROAD NAME LX�G L <br /> LEGAL DESCRIPTION (see tax recei <br /> CONTRACTOR =iA <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURi ADDITION p <br /> SANITARY PRIVY FILLINGRADING CAMPING UNIT SUBDIVISION o <br /> 0 O <br /> o <br /> N r <br /> STRUCTURE/ADDITION USE: o ° <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z v <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 dralntield (DF). <br /> 3. Show dimenslons 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. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sl ned and <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '11 o m <br /> c <br /> PLOT PLAN o 0 <br /> M b <br /> e <br /> s = <br /> N <br /> � 0 <br /> N <br /> O <br /> _ <br /> p y <br /> b <br /> r <br /> I Z <br /> tton f <br /> m c N r>>p <br /> awmM <br /> CONDITIONS OF PERMIT: o Z,: Q c g 0.m <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c o : �Q : -1 <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. °Nq' : O in <br /> PP (including Yaccompanying 1 Y Y 1 5 0 <br /> I declare that this application mcludin an schedule has been examined b me and to the best of knowl- � o : � <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of al informa- N . <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that his infor- ' t 8 i m <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 which may be a result of the County of Burnett relying on this information I am providing i n this ap- <br /> plieation.l spree to permit count officiate charged with administering county ordinances or other authorized pero n to have 0 <br /> access to the above described p s at any reasonable time for the purpose of inspection. N <br /> T <br /> a) N <br /> SIGN HERE <br /> (signature of ow r r ildin tr (date) N' <br /> ZONING ADMINISTRATOR <br /> NNM�NNNN 'Tt <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 888$ $ 89 <br />