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�YL t <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 5 m -1 o <br /> APPLICATION FOR - LAND USE - PERMITS <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 requiremef its of the 1 <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 <br /> rn m <br /> w <br /> OWNER TELEPHONE ')LS-- <br /> ADDRESS <br /> )L -ADDRESS l •, C Cx. .--�� S J g <br /> EMERGENCY/FIRE NUMBER ROAD NAME 'yell, <br /> LEGAL DESCRIPTION (see tau receipt) <br /> � v ' <br /> CONTRACTOR ^ <br /> TYPE OF PERMIT(S): DWELLINGIBUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> 0 <br /> STRUCTURE/ADDITION USE: �l o <br /> (Home/Cabin;Commerc" usiness; Bedroom;Deck;etc.) Z v <br /> P $ r <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) �1 <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate Nort (N). (/V <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. I} {y <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sl ned and <br /> dated by the owner. C o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE UED. '11 c m <br /> c <br /> PLOT PLAN o n <br /> m `^) o <br /> C QJ <br /> 111 l/✓,1 /C n <br /> tl <br /> N <br /> (• J1 ,�I <br /> O <br /> O <br /> m <br /> O y <br /> N <br /> rn <br /> Z <br /> >7 <br /> 1 <br /> S� <br /> M <br /> CONDITIONS OF PERMIT: C <br /> v pN,: � g g <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. to <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. C>g E m <br /> $ gk ` O <br /> e : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of iny knovil O i <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. 14 B p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue it 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 ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> )ccess to the above described promises at any reasonable time for the purpose of inspection. <br /> r 3 <br /> HERE i an E <br /> (signature of owner or i Ing onZL (date) <br /> OMINISTRATOR $ <br /> e+M w�NM M� -n <br /> TOWNSHIP�ULITS MAY BE REQUIRED N N N m <br />