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(h) N LP, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; m o c <br /> APPLICATION FOR — LAND USE — PERMITS 3_ <br /> 70 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 require <br /> mems of the m m <br /> Burnett County Land use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. o <br /> N d <br /> C <br /> OWNER ��eI <br /> TELEPHONE <br /> O <br /> /M � <br /> l O J <br /> �j <br /> ADDRESS Rd <br /> EMERGENCY/FIRE NUMBER ` � l ROAD NAME <br /> J 1 <br /> LEGAL DESCRIPTION (seetaxreceipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> C, 1 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION O <br /> o < <br /> J -+ <br /> STRUCTURE/ADDITION USE, o 0 <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) Z v <br /> o <br /> v <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 dralnfield (DF). o <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. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 0 <br /> dated by the owner. 0 <br /> C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 0 a N <br /> PLOT PLAN Z <br /> m � o <br /> A,4aJ <br /> Che C�YY� a <br /> nn m ; <br /> V . 14 9J1 <br /> o <51 <br /> 0 <br /> J <br /> b <br /> O <br /> J <br /> J <br /> O <br /> re <br /> i <br /> Z <br /> D <br /> CONDITIONS OF PERMIT: a m,: c 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c it Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =ti y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 0 <br /> C <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informa. a «. <br /> G) <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 8 ig o <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 big o <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 haveN <br /> ONO: <br /> access to the above described premises at any reasonable time for the purpose of inspection. m o m <br /> c�1p 3 <br /> m m <br /> SIGN HERE ' m g - <br /> (signature of o ner or building contractor) (date) <br /> ZONING ADMINISTRATOR � <br /> m iv1aruaan <br /> M <br /> TOWNSHIP PERMITS MAY BE REOUIRED o N N <br /> 0 0 0 0 o g N <br />