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Burnett County 7.410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 u <br /> APPLICATION FOR — LAND USE — PERMITS a 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the $ q <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 m <br /> � m <br /> O <br /> OWNER h TELEPHONE $ F <br /> I f �,( m_ m <br /> ADDRESS a <br /> 4 r JG5u 1 � L <br /> EMERGENCY/FIRE NUMBER ROAD NAME SS 1 <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION oV1J, <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` lc <br /> a r- <br /> STRUCTURE/ADDITION USE: 0 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z o <br /> o � <br /> 3 <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 dralnflaid (DF). g <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 <br /> 4. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 y <br /> dated by the owner. C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 o rn <br /> 11 Z c <br /> PLOT PLAN <br /> o n <br /> IN o <br /> A-q,.-a ched cs�n 3: <br /> up tq, <br /> �y <br /> O <br /> o <br /> u <br /> o � <br /> I <br /> z <br />. l <br /> LOU ag8g $ y <br /> CONDITIONS OF PERMIT: �'' Z g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. tg� 77 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r" ' S E i m <br /> -24 <br /> 1 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 Inform&- In <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor• <br /> mation I am providing will be rolled upon by the County of Burnett Wisconsin in determining whether to issue a parmtt. 1 $ 8 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• S`•., <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to haw <br /> access to the above described promises at any reasonable time for the purpose of inspection. n <br /> SIGN HERE <br /> (signature of owner or building contractor) Idarel <br /> G i <br /> ZONING ADMINISTRATOR J'm <br /> TOWNSHIP PERMITS MAY BE REQUIRED o ' f5I '!5 m <br /> 888888',$8 H <br />