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qa 0 <br /> Burnett County 7410 Co. d. K, No. 102, Siren, WI 54872 office of Zoning Administrator � a 3 ? <br /> APPLICATION FOR — LAND USE — PERMITS m a <br /> TO THE ZONING ADMINISTRATOR: 3.The undersigned hereby makes application for a Permit for the work described and c <br /> located as shown herein. The undersigned agrees that ail work shall be done in accordance with the requirements of the 3 n <br /> Burnett County Land Use Ordira nce,Sanitation Code, and with all other applicable County Ordinances and the laws and - o <br /> regulations of the State of Wisconsin. w »' <br /> c '? <br /> m o <br /> OWNER ^CnllN 1 .N1 I I TELEPHONE J'2..L2? - Z7 <br /> ADDRESS 75(o A . SS ' i 1- <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) Q <br /> I <br /> CONTRACTOR +� T'-- <br /> TYPE OF PERMIT(S): DWELLINGIBUILDING GARAGE/ACCESSORY STRUCTURE ADDITION g <br /> n G1 <br /> SANITARY_.. PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 °- <br /> m r <br /> o_ <br /> STRUCTURE/ADDITION USE: v n <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) 0 0 <br /> v <br /> m <br /> DIRECTIONS FOR PLOT PLA14 DRAWING: (Aerial or top view) <br /> 1. Show the location and sizi i of all existing buildings (EB) and all new buildings (NB) and indicate North (N). r <br /> 2. Show the location of the well (W),septic tank (ST), and dreinfield (DF). g <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. 0 <br /> 4. If separate plans are subm tted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> 0 <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. on a 0 <br /> c <br /> Z o <br /> PLOT PLAN O ( a <br /> Uj <br /> M o <br /> C <br /> 0 <br /> �i <br /> I <br /> o <br /> 0 <br /> 0 EY -i <br /> 1 / <br /> Z <br /> � 17 <br /> I ^ <br /> C <br /> R O a=a1 N O O O m <br /> n —i£� 2o33 6 .m ems <br /> m <br /> CONDITIONS OF PERMIT: 0 E j <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. —W <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. —g iz : m <br /> 3. NO GRADING OR SHO ELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o <br /> I declare that this applicatio (including any accompanying schedule)has been examined by me and to the best of my knowl- 0 <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informa. c m <br /> tion contained in this applic tion(including any accompanying schedule)and I further declare that I recognize that this infor- G <br /> mation 1 am providing will relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 ? 0 0 <br /> further accept all liability wh ch may be a result of the County of Burnett relying on this information I am providing in this ap- N <br /> plication.I agree to permit c unty officials charged with administering county ordinances or other authorized person to have moo <br /> access to the above describ d premises at any reasonable time for the purpose of inspection. r . 0 o <br /> m <br /> 1 � <br /> �� <br /> SIGN HERE _ tMefe)- o t E <br /> }I I $ <br /> ZONING ADMINISTRATOR '� V ' rl T <br /> TOWNSHIP PERMITS MAY BE REQUIRED ��t'1APR J o m p m� c `V m <br /> $ <br /> 00000o ' o <br /> 00000004) <br />