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COO <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI SU72 Office of Zoning Administrator u ; o 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work desci and a 0 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnes County Land Use Ordinance,Sankffikxt Code,and with all other applicable County Ordinances and the laws and _ <br /> $ r <br /> regulations of the State of Wisconsin. m <br /> m m <br /> $ { O <br /> OWNER � ,I � 5 a �/, � TELEPHONE <br /> ADDRESS ;7L� <br /> EMERGENCY/FIRE NUMBER � _ ROAD NAME <br /> LEGAL DESCRIPTION see tax receipt) i '�' <br /> I V' <br /> CONTRACTOR J / _ �i Q% <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE X ADDITION <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION c Iii. C% <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) z o <br /> a o <br /> m <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). <br /> 3. Show dimensions In feet of thefollowing:(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. 0 <br /> 4. It separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. c 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE UED. o <br /> KEvT <br /> PLOT PLAN <br /> QuSI®k "4 0-"'0 <br /> * n <br /> Would k 38 III o 50 a <br /> g7�� Y d <br /> w <br /> o � < <br /> IN <br /> ` O <br /> 0 <br /> F <br /> `Db_y L Z <br /> i <br /> ma <br /> CONDITIONS OF PERMIT: Ni <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <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. i '• gg ` m <br /> X ? <br /> 10 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl• O <br /> edge and belief it Is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of a I informa- M m i m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing n thio ap- <br /> plication.1 agree to permcounty officials c arOb with administering county orolnances or other authorized pen to have - <br /> access to the above abed premises noble time for the purpose of inspection. T <br /> SIGN HER �� n �� •+. t <br /> (signs f owner or Ing contractor) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BER ��I EDM 2 619% �o !X Z5 N '! m <br /> L ;� _ 8888888'8 a, <br />