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ON COMPUTEMSCANOED <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Adminletrator m m o O <br /> APPLICATION FOR - LAND USE - PERMITS m <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w � <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Lard Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. m <br /> u et <br /> c <br /> 66 _ADOWNER TELEPHONE g46 - <br /> ADDRESS <br /> DRESS rA <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> I <br /> a/ <br /> LEGAL DESCRIPTION (see tax receipt) y9 6 34y 9 16 W L? S C ✓ <br /> CONTRACTOR 1i F / C PRT L 07 y B L/(;3Fi <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> c1 <br /> SANITARY PRIVY FILLING/GRADIN CAMPING UNIT SUBDIVISION 0 ° Y <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Busi ss;Bedroom;Deck;etc.) Z v <br /> 0 0 <br /> v <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 dralnfield (DF). I 5 <br /> 3. Show dimensions Infest of thefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building -1 <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 <br /> 4. R separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be all;ned and X <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 3 m <br /> PLOT PLAN o S <br /> o <br /> C n <br /> SE <br /> �J <br /> C0 <br /> N <br /> m <br /> v � <br /> N <br /> 1• v <br /> i; <br /> C <br /> eFZ2.nE& my <br /> CONDITIONS OF PERMIT: ,Z-�. Q C B 8 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c E IQ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N 33 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N 6 ni I m <br /> I declare that this application(Including ar1Y accompanying schedule)has been examined by me and to the best ofmy knowl- <br /> edge <br /> now)edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of II informs- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> motion 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 in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> 0: p <br /> access to the above described promisee at any reasonable time for the purpose of inspection. . <br /> m <br /> SIGN HERE a <br /> (signature of owner build ng <br /> t (dots) <br /> ZONING ADMI STRATOR '• g: i <br /> TOWNS ERMITS Y REQUIRED $. fi N5 m <br /> 8E 8�8'8 ai <br />