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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 0 <br /> PPLICATION FOR - LAND USE - PERMITS 3 0 <br /> 0 <br /> TO THE ZONING ADM NISTRATOR:The undersigned hereby makes application for a Permit for the work described and m �, <br /> located as shown here'n. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land U 5e Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. <br /> c <br /> m o <br /> OWNER Yi- 'LI TELEPHONE o <br /> r1 <br /> d <br /> ADDRESS <br /> EMERGENCY/FIRE NUM ER ROAD NAME - <br /> LEGAL DESCRIPTION ( e tax receipt) <br /> I <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O <br /> SANITARY X\__ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o o — <br /> STRUCTURE/ADDITIONSE: ° o <br /> (Home/Cabin; omrrercial Business; Bedroom; eck;etc.) Z o <br /> DIRECTIONS FOR Pl.OT 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). fj <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). 4 <br /> 3. Show dimensions i i feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building .4 <br /> measurement to the ordinary high water mark of lake,stream,or river. C <br /> 4. If separate plans We submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owne . o <br /> NOTE: BUILDING/STRUC URE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. In cn <br /> 1I Z Q <br /> PLOT PLAN ° a <br /> M o <br /> C I <br /> m <br /> G <br /> �nt <br /> w <br /> m <br /> ° <br /> q o <br /> IN N <br /> O 0 <br /> 7 <br /> O � <br /> N <br /> v Z <br /> � D <br /> O U.' rNcDi LICE, lu <br /> 2.0. a m m <br /> N <br /> 9 lu <br /> CONDITIONS OF PERMIT <br /> 1. DRIVEWAY MUS MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f o <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. S <br /> "; <br /> 3. NO GRADING O SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o 3 O i iO <br /> gig <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o C <br /> edge and belief it is t us,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs i "I a; m <br /> tion contained in thiapplication(including any accompanying schedule)and I further declare that I recognize that this infor- is <br /> malion I am providin will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I ov o <br /> further accept all Its ility 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 rmit county officials charged with administering county ordinances or other authorized person to have i i iO u, 0 <br /> access to the above ascribed premises at any reasonable time for the purpose of inspection. m 3 0 R ' <br /> D 9 A x <br /> SIGN HERE :jLf ' ( fret -. <br /> ZONING ADMINIST ATOR <br /> APR I A 1994 ANN NNN� � <br /> TOWNSHIP PERMIT AY BE REOUI�t 101 I !; o u, m . u u 8 u m <br /> m <br /> �� bob bbbo <br /> 000 00000 <br />