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Burnett County 7410 Co. I td. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m ' o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> 0 <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 u dersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordini ince,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wiscc nsin. N m <br /> / m <br /> OWNER TELEPHONELD el / A <br /> ADDRESS WDVXANrTS13uQC- L-Ji. <br /> � <br /> S gt <br /> EMERGENCY/FIRE NUMBER262 <br /> ROAD NAME Ga S0 f 4�G1 <br /> LEGAL DESCRIPTION (seetexrec ipt) ) ( 11 <br /> i <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/3UILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> n <br /> SANITARY_ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> < n <br /> 0 — L <br /> y r <br /> STRUCTURE/ADDITION USE: o ° <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z 0 <br /> o ° <br /> a <br /> J <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 thew II (W),septic tank (ST),and drainfield (DF). Z) <br /> 3. Show dimensions in feet oft efollowing:(a)building to all lot lines,(b)building to center line of road,(c)building -W --� <br /> measurement to the ordinary high water mark of lake,stream, or river. O I}- <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LO TIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a N <br /> PLOT PLAN o n <br /> M y <br /> cl <br /> aW <br /> Me <br /> I I. <br /> film <br /> m <br /> ° <br /> 0 <br /> 0 y <br /> >11 <br /> N <br /> Z <br /> CONDITIONS OF PERMIT: v m y: -R c 8 0 Z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F <br /> 2. REMOVAL OR CUTTING O TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =m y <br /> 1 NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. - m <br /> of ' O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- t�i : - <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- a m«. <br /> tion contained in this applicatio (including any accompanying schedule)and f further declare that I recognize that this infor- v �" a <br /> 0 : <br /> p <br /> mation I am providing will be r lied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 <br /> further accept all liability which nay be a result of the County of Burnett relying on this information 1 am providing in this ap- <br /> plication.I agree to permit coun y officials charged with administering county ordinances or other authorized person to have O N p <br /> access to the above described remises at any reasonable time for the purpose of inspection. ro b <br /> 0 <br /> SIGN HERE I 1 -. . . . . g <br /> o : - <br /> : <br /> �: S <br /> 70 <br /> ZONING ADMINISTRATOR / 'OF <br /> 77 <br /> 8 <br /> Z-: <br /> TOWNSHIP PERMITS MAY BE REOUIRED : o N UN N N N 8 N m <br /> MAY - F 1994 <br /> 000000000 <br />