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8-/LCL')�jI <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator W a f o <br /> APPLICATION FOR - LAND USE - PERMITS20 <br /> �q <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <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. w m <br /> A <br /> O <br /> OWNERf C I TELEPHONE / f <br /> ADDRESS) C /✓!/ 37// Ira P ( •�— ��6 ✓ 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME / ' <br /> �Q <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR J� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o !� <br /> n Ll Jl <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> 0 <br /> STRUCTUREIADDITION USE: 0 V <br /> (Home/Cabin; ommercial Business;Bedroom; Deck;etc.) Z o <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) I } <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). r <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (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 i building <br /> measurement to the ordinary high water mark of take, stream,or river. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sl nod and <br /> dated by the owner. c <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I 3 y <br /> PLOT PLAN ° <br /> / M o <br /> '�Oe view <br /> C I <br /> CI <br /> A10sc� -r— , -- <br /> � 00 <br /> 40 s�fr�ur 1 ess'� <br /> m <br /> 4 <br /> W <br /> 3° v raav v <br /> IN 33 <br /> CONDITIONS OF PERMIT: m g�'z C8 =0 r. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Ze �'z <br /> o f . rn: <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. N s m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 2S i <br /> 4g ; P O <br /> I 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 1 am responsible for the detail and accuracy of all informs- a m a : 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 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 providin in this ap- lF : <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have O , o <br /> access to the above described pre sea y reason time f the purpose of inspection. my to <br /> m b <br /> SIGN HERE <br /> (signature of #or building contractor) (date) . <br /> . <br /> ZONING ADMINISTRATOR <br /> �M MM�+M MNH -t <br /> TOWNSHIP PERMITS MAY BE REQUIREDo 4n1 S a Ni 'a'$ m <br /> $ $$ $$ 88$ ai <br />