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Bumett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 5 m - c <br /> APPLICATION FOR - LAND USE - PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements Of the m = -n <br /> Burnett County Lend Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. o C9 <br /> OWNER /7/Q FJ�� TELEPHONE m VL, E <br /> ADDRESS a r� �'/_ • / 1 %764 '"/�G sty, ��,�+ <br /> /y✓%/fDID'0 W u6yd-l7 o m <br /> EMERGENCY/FIRE NUMBER �pJ��� ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> (� U <br /> CONTRACTOR �i�T 1 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n <br /> SANITARY PRIVY FILoLING/GRADING O <br /> CAMPING UNIT SUBDIVISION o C) <br /> 0 » <br /> w <br /> STRUCTURE/ADDITION USE: Deck c 0 o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z <br /> 0 i <br /> 0 <br /> m <br /> a <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). c <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to carder 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 besigned and 0 <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 o <br /> PLOT PLAN m <br /> z co 7c <br /> ,7 ^ / A o npJ <br /> / /V / <br /> C I <br /> X <br /> J <br /> 0 <br /> O o <br /> Iv <br /> Z <br /> n <br /> Io9 <br /> 3 <br /> Via§ rn <br /> CONDITIONS OF PERMIT: w <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p 0 m' Y Z <br /> > � i NE <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ' re i i G1 - i m <br /> PP (including Yaccompanying 1 Y Yknowl- <br /> edge <br /> 1 declare lost this application Includin an schedule nes been examined b me and to the best of m <br /> and belief it is true,correct and complete.I acknowledge that I am res m <br /> P g responsible for the detail and accuracy of all informs- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- �' B m <br /> motion 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. 1 agree to permit county officials charged with administering county ordinances or other authorized person to have - p <br /> access to theabo described premises at any reasonable time for the purpose of inspection. @Q <br /> T '2i <br /> i gg <br /> iei <br /> SIGN HERE <br /> Igna f ro Ilding contactor) (date) �f <br /> i <br /> ZONING ADMINISTRATOR <br /> NNN�+N' 'n <br /> TOWNSHIP PERMITS MAY BE REQUIRED m <br /> 8888888'8 UP <br />