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i <br /> Burnett County 7410 Co. Rd. K, No. 102,-Siren, WI 54872 Office of Zoning Administrator m 71 o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> m d <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <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 3 `� <br /> regulations of the State of Wisconsin. o OC <br /> � a <br /> N v <br /> OWNER <br /> y 1 /J� TELEPHONE 3��/ aiE <br /> ADDRESS /`- <br /> ,303,;),J Ll?o <br /> EMERGENCY/FIRE NUMBER 3 O (7 ROAD NAME <br /> LEGAL DESCRIPTION <br /> �1 (f(see tax receipt) Lot � 5/"' L10 <br /> CONTRACTOR <br /> �(/�zg/�yD <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> 0 0 <br /> SANITARY PRIVY /J FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: 6 <br /> ,w nn.e5AfG 14 Z_ /Sq�A r/ o <br /> (Home/Cabin;Commercial Business; Bedroom; Decl(-,etc.) 0 <br /> Z o V <br /> 0 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). <br /> 2. Show the location of the well (W), septic tank (ST), and drainfield (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 <br /> measurement to the ordinary high water mark of lake,stream,or river. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 0 <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I o ur <br /> c <br /> PLOT PLAN o a <br /> m n = <br /> i5,bao v o <br /> A-Ad G <br /> I z <br /> i <br /> D o c v m 0 am <br /> m a'� C N 0 � <br /> CONDITIONS OF PERMIT. m o S _3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F � <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE, TM '' I m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �" 'm ^ 1 C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m a I m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- w m fn O <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 providing in this a w <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises r3pa5p1ble 1iqeWqthe purpose of inspection. °i $ '� <br /> T A m :n <br /> A b <br /> SIGN HERE <br /> (5 re of oone or buildin contractor) (date) f ' <br /> o ' x ' <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REOUIRED N� ' N `" m <br /> ut rn o p o , m <br /> 8888 $ $ 8tto <br />