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CEJfl r <br /> Burnett County 7470 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator y 0 o <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the e C <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. u m <br /> OWNER ?/DV r1CIV��� TELEPHONE76-s- <br /> ADDRESS 13'70C, <br /> fW <br /> 31S?RAM R-0. ('90g BUg66 j u <br /> EMERGENCY/FIRE NUMBER ROAD NAME l/ <br /> LEGAL DESCRIPTION (see tax receipt) <br /> G \ <br /> CONTRACTOR 1 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o r` <br /> o <br /> SANITARY_>< PRIPRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION <br /> w <br /> STRUCTURE/ADDITION USE: ° <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) °Z d <br /> 0 <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). r <br /> 2. Show the location of the well (W),septic tank (ST),and draiMield (DF). t 4 <br /> 3. Show dimensions In feet of the following:(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 9 <br /> dated by the owner. Q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. c to <br /> Z v <br /> PLOT PLAN o n <br /> M O e <br /> cC <br /> i <br /> o s <br /> 0 <br /> m I , <br /> o <br /> I <br /> 2 <br /> I <br /> f <br /> 8 9' to m <br /> 0 <br /> ELF 4 - a <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 0 'z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. .i r" '• O G <br /> 1 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 informa- W': : S �+m m <br /> tion contained In this application(Including any accompanying schedule)and I further declare that 1 recognize that this infor. E p <br /> motion 1 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 /> access to the above described premises at any reasonable time for the purpose of Inspection. T <br /> i <br /> SIGN HERE r I�� . <br /> �2 e�t�l <br /> ZONING ADMINISTRATOR 'S <br /> TOWNSHIP PERMITS MAY BE REOUIR f � i 'R m <br /> 0 88 88188 vi <br />