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6Aw' '� � t <br /> Btanett Cdunly 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Admi rdstrator S : c <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO TF(E ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirem rns of the g 4� <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and th laws and _ <br /> regulations of the State of Wisconsin. <br /> m � <br /> c <br /> OWNER � ,a. l TELEPHONE t e <br /> 3E <br /> � O = <br /> ADDRESS 19� �LLJ G-�Ice <br /> EMERGENCY/FIRE NUMBER ���) ROAD NAME <br /> LEGAL DESCRIPTION (seetaureceipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n O <br /> SANITARY PPRIVYo <br /> FILLING/GRADING CAMPING UNIT SUBDIVISION o ^. <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z <br /> 0 0 <br /> 0 <br /> J_ <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 dreinflaid (DF). ?9� 0 <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building 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 igned and 9 <br /> dated by the owner. 0 2 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED, 1I 3 rn <br /> c <br /> PLOT PLAN A Z <br /> m o <br /> C <br /> CV <br /> Z <br /> r m <br /> 0 <br /> o` <br /> CCJ <br /> _ <br /> o � <br /> I <br /> Z <br /> 11 <br /> M m <br /> CONDITIONS OF PERMIT: e D g� I a 33 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z e ? Q . <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. c _ ` �',--in` i M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m <br /> k ` O <br /> $ EE <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs• In <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- rY i <br /> matlon 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 p <br /> access to the above described premises at any reasonable time for the purpose of inspection. ' <br /> m $ <br /> 7 <br /> SIGN HERE 07 N <br /> (signature of owns bu ng (date) <br /> n N <br /> ZONING ADMINISTRATOR $ <br /> NNN M NN+ 'n <br /> TOWNSHIP PERMITS MAY BE REQUIRED i$ g m <br /> um, <br />