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ni C . <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator c ; o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m °� <br /> Burnett County Land Use ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. _o PO <br /> OWNER TELEPHONE n FO <br /> ADDRESS <br /> to 1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt)Gbi/ !B+r') JCC- it , H,9 W � <br /> CONTRACTOR �— f I <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> 1 <br /> n Ll <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> o < <br /> H <br /> r <br /> STRUCTURE/ADDITION USE: o ° <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z <br /> ° o <br /> 0 <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 drainflaid (D17. <br /> 3. Show dimensions In feet ofthefollowing:(a) building to all lot lines,(b)building to center line of road,(c)building q <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 <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I v N <br /> PLOT PLAN o a <br /> Aes <br /> bQ <br /> b'0lvtiLt frR 511* L C <br /> N <br /> o <br /> i <br /> bob <br /> off <br /> i o <br /> Spp. <br /> t <br /> i <br /> cW r o c.C <br /> 2am am m <br /> D -'. In m <br /> CONDITIONS OF PERMIT: c $ <.: Q CS . r. <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e m 9.� - 8 Z : =12. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. � :fl N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 'No ; O O <br /> E <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o' C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- «.m.n: m <br /> tion contained in this application(including any accompanying schedule)and 1 further declare that 1 recognize that this infor g <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I oo <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O N o <br /> access to the abov described premises at any reasonable time for the purpose of inspection. : m b a <br /> m <br /> A3W <br /> m � � A N <br /> SIGN HERE <br /> (signs �e f own ilding contractor) <br /> . �€ <br /> ZONING AD ISTRATOR 8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED O N N UO N N p N m <br /> 0000obb6m <br /> 00000000rn <br />