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(D1 / <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m a <br /> -0 THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and mc r " <br /> scaled as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 3 0 SVS: <br /> 3urnetl County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and o <br /> N d <br /> .equlations of the State of Wisconsin. 1p m <br /> Senn I`� U6 al�� o <br /> OWNER TELEPHONE,, 1 p <br /> ADDRESS a (0IQ �Aj ��PI(/1 R� �.�x�[✓�� VV—L- ��t� <br /> EMERGENCY/FIRE NUMBER -�,r�_� 1 ROAD NAME _ I <br /> LEGAL DESCRIPTION (see tax receipt) <br /> _ 1 <br /> CONTRACTOR ! �') bi-ne (. _ P I u nxbc I? <br /> TYPE OF PER IT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n L7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION0 °. --' <br /> r- <br /> 0 0 <br /> STRUCTURE/ADDITION USE: v <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc-) 0 0 <br /> 0 <br /> m <br /> a <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 the well (W),septic tank (ST), and drainfteld (DF). o <br /> 3. Show dimensions In feet of thefollowing:(a) buildingto 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. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on a m <br /> 71 Z `Q <br /> PLOT PLAN q n I' <br /> m 5J o ilk�§1y) <br /> c I <br /> M <br /> C! < �` `1 <br /> �1 0 <br /> a <br /> 0 <br /> o � <br /> o <br /> N_ <br /> !,�eep;(P4 Sanff �ez�rtI VOL- <br /> 33 <br /> a4 am cm M <br /> CONDITIONS OF PERMIT: ^ < no.j 1 8 ro <br /> 1, DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E 5 �'z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. a.»1: rn <br /> m <br /> �' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- , : o r m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs. .�m H m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B 8 : G <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I rl f ; $`I3 $ <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- d, <br /> plication.I agree to permit county officials charged with administering county ordinances or other authonzed person to have O p <br /> access to the above described premises at any reasonable time for the purpose of inspection. r ; 3 $ ; <br /> N m AM : <br /> N w O <br /> SIGN HERE - �^ <br /> (signature of owner or building contractor) (date) 8 s <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 00 <br /> 00 <br />