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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 'a �� Z <br /> m £ o <br /> APPLICATION FOR - LAND USE - PERMITS . <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes ° <br /> 9 by application for a Permit for the work described and m C <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 3 n <br /> regulations of the State of Wisconsin. — o <br /> m m <br /> m m <br /> /�'I SI�FiP/� m <br /> OWNER 1 TELEPHONE n E <br /> O � <br /> ADDRESS 4 <br /> YecaCrQz AwAlfm <br /> EMERGENCY/FIRE NUMBER �1 C f ROAD NAME l <br /> LEGAL DESCRIPTION (seetaxreceipt) 111 NNN"'TTT <br /> CONTRACTOR !s ag /4-, h�S /®-f/ // <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDRION p <br /> SANITARY PRIVY F FILLING/GRADING CAMPING UNIT SUBDIVISIONo o tl ' <br /> STRUCTURE/ADDITION USE: 3c) J <br /> o <br /> (Home/Cabin;Commercial Business;Bed m;Deck;etc.) Z <br /> v <br /> o ° <br /> 9 <br /> 3 <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 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. r t <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and v 1 <br /> dated by the owner. 9 M O <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTE VERIFICATION BEFORE A PERMfi CAN BE ISSUED. a v+ <br /> PLOT PLAN o a <br /> m o <br /> C I ° <br /> I <br /> IL <br /> N <br /> O <br /> N I <br /> Y � <br /> O � <br /> {� IN <br /> N` <br /> o c m m a F MM <br /> CONDITIONS OF PERMIT: o A Z m c N o 9 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F ? ? <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ° <br /> m 2 ` C) <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- . a <br /> 0 o : m <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- m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I M <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- iw <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O N <br /> access to the above scribed premises at any reasonable time for the purpose of inspection. ro <br /> M M <br /> 7�0 9-Z M <br /> SIGN HERE <br /> (sign re of owner or building contractor) i n i <br /> (date) o x : <br /> ZONING ADMINISTRATOR $ <br /> H ' <br /> TOWNSHIP PERMITS MAY BE REQUIRED T <br /> N N M i O 91 .0 O O m <br /> $ 88888 rmn <br />