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Burnett County 7410 Co. Illd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator o 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3 <br /> TO THE,ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and rn <br /> located as shown herein. The u idersigned agrees that all work shall be done in accordance with the requirements of the <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. rn m <br /> '^ m <br /> c <br /> m � <br /> OWNER '`�� TELEPHONE 2�/w l-. 2� n <br /> ADDRESS 35 l- W/ L7 CT- PAV,UURy or S lQ <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax rec-ipt) <br /> _ I <br /> CONTRACTOR �1 <br /> TYPE OF PERMIT(S): DWELLING/3UILDING GARAGE/ACCESSORY STRUCTURE ADDITION o lam\ <br /> 0 <br /> SANITARY� PRIVYo <br /> FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> N r <br /> STRUCTURE/ADDITION USE: a ° <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z <br /> o <br /> a <br /> m <br /> a <br /> DIRECTIONS FOR PLOT PLAI I 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). 1 <br /> 2. Show the location of thew DII (W),septic tank (ST),and drainfield (DF). <br /> 3. Show dimensions in feet of I he following:(a)building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordina high water mark of lake,stream, or river. C <br /> 4. If separate plans are submi ted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. IN 3 ur <br /> PLOT PLAN A = a <br /> m 9 <br /> C <br /> U � <br /> AV(1160 <br /> 1 l _ <br /> OCD <br /> , m <br /> O <br /> J <br /> m <br /> O ,y <br /> y <br /> z <br /> m �c�5rr> > <br /> rn <br /> CONDITIONS OF PERMIT: v n ,2 C8 0 3 <br /> 1. DRIVEWAY MUST MEET D 11VEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o <br /> 2. REMOVAL OR CUTTING F TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. F3i j =y j i 7) <br /> 3. NO GRADING OR SHOREI.AND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> N i i cit ( m <br /> g m C <br /> I declare that this application(it cluding any accompanying schedule)has been examined by me and to the best of my knowl- o <br /> edge and belief it is true,correc and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- rn ro.n M <br /> tion contained in this applicati n(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� g <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. y, <br /> plication.I agree to permit cour ty officials charged with administering county ordinances or other authorized person to have m N <br /> access to the above described remises at any reasonable time for the purpose of inspection. r . 3 g , <br /> N C A m <br /> SIGN HERE _ <br /> (si nat wrier or ulldin actor) - (date- i W': - ' <br /> Pi <br /> ZONING ADMINISTRATORz S <br /> s i <br /> ! xr H w -n <br /> OWNSHIP PERMITS MAY BE REOUIR* 0 m <br /> u�l L___---- { 0 8 0 8 0 vm) <br />