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BurNttCrounty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> o c <br /> ` APPLICATION FOR — LAND USE — PERMITS m <br /> oa <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m c <br /> located as shown herein. The undersigned 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 P VV <br /> regulations of the State of Wisconsin. m <br /> m (j <br /> OWNER FjCjAjRKQ W61 j< TELEPHONE <br /> ,,11!! f TELEPHONE (oIZ . 279 — �1 (ol m �0 <br /> ADDRESS J.(000 C) G STO ii 1� `V - �� 0 <br /> EMERGENCY/FIRE NUMBERL41SROAD NAME <br /> I <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION / p <br /> SANITARY >C_ PPRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION a o <br /> H � <br /> STRUCTUREIADDITION USE: ° <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z o <br /> ° <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) q�vl- } <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NS) and Indicate North (N). IAI <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). t o <br /> 3. Showdimensions Infeet of thefollowing:(a) buildingto all lot lines,(b)buildingto center line of road,(c)building -4 <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. C o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a <br /> PLOT PLAN ° <br /> A N. I T ) <br /> C O (S <br /> mma M <br /> I <br /> N� <br /> L <br /> 8 0 <br /> o <br /> m <br /> o <br /> a <br /> Z <br /> � 1 <br /> I m <br /> g� - a <br /> CONDITIONS OF PERMIT: a 2;: C8 g,3 ,_ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN a0 DAYS OF PERMIT ISSUANCE. Z a I Q : ; � <br /> e f ' _N: X1 <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. �! rn 0 <br /> >' i <br /> C <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best Df 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 1 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 iss e a permit. I i $`i3 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providl rig in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have Q: <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE <br /> (sign uro of owns or I In ntractor) (date <br /> ZONING ADMINISTRATOR ` g '• <br /> TOWNSHIP PERMITS MAY BE REQUIRED LR 8 rr <br /> 888 888$ u <br />