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0)� COOT <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 00, v z <br /> � m f o <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 •Z rA <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <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 <br /> w d <br /> ^ w � <br /> OWNER TELEPHONE 7is- rr3s— w O <br /> a <br /> ADDRESS <br /> EMERGENCY//FIRE NUMBERROAD NAME . <br /> a� 7 9 7 <br /> LEGAL DESCRIPTION (see tax receipt) Al _y� /lpeT39N �ll� <br /> CONTRACTOR 7I � ^ /J G- VV <br /> TYPE OF PERMIT(S9): DDWr,ELLINGG//BBUILDINGfj GARAGE/ACCESSORY STRUCTURE X ADDITION <br /> o L/ <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabi Commercial BusineW Bedroom;Deck;etc.) Z 71 <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 0 <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). o <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 <br /> dated by the owner. G o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. <br /> PLOT PLA f-f NpRTA � o n <br /> C <br /> 29° C) <br /> A <br /> 0 <br /> _ <br /> O <br /> c <br /> _ <br /> r <br /> �t f �p6�L 1_ o <br /> 6 Z <br /> r� z <br /> 3� SG P' _ <br /> (¢a4S t <br /> 36 � <br /> 141, If <br /> 9� <br /> CONDITIONS OF PERMIT: v' m N.: •2 c� .� r.1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. = m'o: 2 — <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P E <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N 3)o m <br /> o : B o ; O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. <br /> 0 . <br /> C <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 Rl <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B <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 - ' <br /> plication. 1 agree to permit county officials charged with administering county ordinances or other authorized person to have N- <br /> access to the above described premises at any reasonable time for the purpose of inspection. w "' <br /> It <br /> SIGN HERE <br /> (III ureof v r or building contractor) <br /> ZONING ADMINISTRATORS Er <br /> I r• <br /> o i i <br /> TOWNSHIP PERMITS MAY BE REQUIRED II' i, i j o N N N N N N m <br />