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Burnett CouEty 7410 Co. Rd. K. No. 102, Siren, WI 54872 Office of Zoning Administrator u o c c <br /> APPLICATION FOR — LAND USE — PERMITS 5. f <br /> m ° <br /> 0 <br /> TO THE 70NING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � v <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 <br /> regulations of the State of Wisconsin. m <br /> OWNER 1?011 <br /> / I��p1,n19 TELEPHONE JL('_ q6Z� 273$ = m <br /> m �'t <br /> £ <br /> o (� <br /> ADDRESS 17ST O K£Q FCO J—I—• I I <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) C <br /> CONTRACTOR <br /> 1 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n G1 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> J - <br /> m � <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z o <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 (VV),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 IJ <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 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSFE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1A v m <br /> 1A Z a <br /> PLOT PLAN ° n <br /> / /� � ° IIGf J`�1 <br /> TI//rImgo p Q <br /> M L <br /> G 1-' <br /> m <br /> U! <br /> ° <br /> G li <br /> w <br /> C <br /> Z <br /> Z <br /> Er & Y2 �cb�le form �� <br /> ,SES �e�nd,-��-��a 1 m -� *)0q_7 � <br /> R m <br /> o Dg.* 2.a2y <br /> CONDITIONS OF PERMIT: g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e f ; �N; <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. g ' m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m <br /> QQ P ` C <br /> 5i <br /> I declare that lois application(Including any accompanying schedule)has been examined by me and to the best of my knowl- g <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- '. �+ �` In <br /> lion contained in this application(Including any accompanying schedule)and I further declare that I recognize that this Infor- <br /> motion 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 ap- <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 at any reasonable time for the purpose of inspection. m <br /> SIGN HERE <br /> ( I 14ata1 <br /> ZONING ADMINISTRATOR <br /> w�w� �1 <br /> TOWNSHIP PERMITS MAY BE REQUIRED OCT 9 f> �+ N'd m <br /> �� ' ; 88�88,8I8 vmi <br />