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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator rn '0 Z <br /> o £ o <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> v <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permitfor the work described and . o <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the om <br /> m } <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 0 <br /> regulations of the State of Wisconsin. y o <br /> w <br /> c <br /> m <br /> OWNER O <br /> ` `/ TELEPHONE a £ <br /> ADDRESS ( V. pa <br /> � <br /> EMERGENCY/FIRE NUMBER '75 ,4 ROAD NAME - U <br /> r✓"?? <br /> LEGAL DESCRIPTION (see tax receipt) 1.0tCj' 8�, q fin n VA, f <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n o0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ^ <br /> '^ r <br /> STRUCTURE/ADDITION USE: s <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> 0 0 <br /> a <br /> m <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 ofthefollowing:(a) building to all lot lines,(b)buildingto 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 9 <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on 3 rn <br /> PLOT PLAN Mill Z <br /> o 'a� <br /> fn o <br /> C <br /> M <br /> "' -� 3 <br /> 160 <br /> r <br /> c <br /> Phi <br /> Z <br /> 30 to Ll L afl-(---� i <br /> w�l � <br /> -. a NN � Nr DDp U <br /> m O c m oro n £ <br /> o- m w s M <br /> C NDITIONS OF PERMIT: <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f 5 ? . 0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ »' m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m n I b <br /> g ac : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- ` » m m <br /> edge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all informa- 1 er m ea : 0 <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. I g m g <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing it this so N <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O utp <br /> access to the above described premises at any reasonable time for the purpose of inspection. m g 2 <br /> m 3 r : <br /> A N <br /> SIGN HERE <br /> (sig u of owner o ding contractor) (date) w ` FVa <br /> ZONING ADMINISTRATOR U i S ' <br /> TOWNSHIP PERMITS MAY BE REQUIRED N NO= N 8 8 `0{ m"� <br /> NNll� m <br /> 88ggggggrn <br />