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Burnett Coenty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator u m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m 1 1 <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. — o <br /> N d <br /> N � <br /> C <br /> m <br /> OWNER <br /> T-fi�f 17 TELEPHONE <br /> jrICNE/ 1 a c E <br /> o <br /> ADDRESS 'qo3z DRcNR,tnBRaaKLyn! Meg Mn! 55 V43- <br /> EMERGENCY/FIRE NUMBER ROAD NAME I <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNITSUBDIVISION 0 <br /> o < <br /> m R <br /> J <br /> STRUCTURE/ADDITION USE: 5 0 <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z v <br /> 0 0 <br /> 9 <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 drainfield (DF). rte. <br /> 3. Show dimensions infeet ofthefollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)building <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. o C� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 0 a <br /> O u, <br /> PLOT PLAN z Q <br /> A o a <br /> m o <br /> C <br /> ftTn(-f4ing leLC) Ougyh <br /> m <br /> y <br /> ��►�,k,2� lcL� �� o <br /> s�8 <br /> N <br /> O <br /> J <br /> b <br /> O � <br /> Z <br /> inc 0�m o a:E <br /> g.� oto-; 9,m m <br /> CONDITIONS OF PERMIT. g m y;: E c g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F Z r <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. m y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. a Zj 2 m <br /> of i a2E I D <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 informa- <br /> rn <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- o! o p <br /> mation 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 O p <br /> access to the above described premises at any reasonable time for the purpose of inspection. m <br /> Cj i1 n� A 0 i <br /> N 0 <br /> SIGN HERE <br /> (si nature o w r uil tractor) te) <br /> ZONING ADMINISTRATOR <br /> H <br /> TOWNSHIP PERMITS MAY BE REQUIRED _ _ —! 0 N m <br /> 8 0 08 W <br />