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lumetr Coupty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator c o <br /> APPLICATION FOR — LAND USE — PERMITS Q w <br /> application for a Permit for the work described and m <br /> O THE ZONING ADMINISTRATOR:The undersigned Hereby makes e d accordance $ <br /> x:ated as shown herein. The undersigned agrees that all work shall be doneca�in Amy O din the <br /> nances and the(laws and _ o o� <br /> lurnett County Land Use Ordinance,Sentio"Code,and with all other apps m <br /> egulations of the State of Wisconsin. $ m f <br /> 1 `i,, TELEPHONE <br /> 1 O m <br />)WNER V ,-PAC-Jr �+ o <br /> 4DDRESS O` r y`t S �n <br /> (Zt d � pre <br /> ROAD NAME <br /> EMERGENCY/FIRE NUMBER <br /> LEGAL DESCRIPTION (see tax receipt) I <br /> CONTRACTOR O <br /> ADDITION <br /> TYPE OF PERMIT(S): DWELLINGIBUILDING <br /> GARAGE/ACCESSORY STRUCTURE o C <br /> VISION <br /> SUBDI <br /> FILUCAMPING UNIT m <br /> SANITARY�- PRIVYNG/GRADING o <br /> 0 <br /> Ste.: <br /> STRUCTURE/ADDITION USE: 0 <br /> 0 0 <br /> (Home/Cabin;Commerci usiness;Bedroom;Deck;etc.) m <br /> } <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 dralfNleld (Df). <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building O <br /> measurement to the ordinary high water mark of lake,stream,or river. O <br /> 4. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plana must be signed and O o <br /> dated by the owner. <br /> c <br /> c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE SSUE c o. <br /> PLOT PIAN <br /> 111 0` <br /> C <br /> a � <br /> 0 <br /> I <br /> 4- <br /> o a <br /> 0 <br /> o IVU <br /> m <br /> a <br /> I� <br /> Z <br /> 9-1 <br /> ' 7D <br /> f <br /> ROlt <br /> g 3 <br /> c g 8 3 <br /> z m�• ffiz : <br /> CONDITIONS OF PERMIT: ur - <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 0 4 ; O ' <br /> i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. E - r <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ' Q ?. . <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best or my knows- <br /> In schedule)and s further doctors that I recognize that this Infor- g <br /> edge and belief it is true, R <br /> (including accompanying that s du responsible for the detail and accuracy or all informs* <br /> tion contained in this applicationg <br /> n p the County of Burnett Wisconsin in determining whether toIssueloripthis ermit- 8 <br /> motion 1 am providing will be rolled uiro Y Of non to have <br /> further accept all liability which May ba a result of theitnooudnminis ering Burnett <br /> ordinances f or other authorized peg T <br /> Pilo I agree to permit county officials charged reasonable time for the Purpose of inspection. .[ <br /> se to the chow described Promises al any 's <br /> access M i <br /> M; <br /> (date) <br /> SIGN HERE (signalurs of OwnIlIr or building CO <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIREDg <br />