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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m o a <br /> APPLICATION FOR — LAND USE — PERMITS3. — <br /> d a <br /> TO THE ZONING 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 n <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. H m <br /> c <br /> n 0 <br /> OWNER TELEPHONE <br /> V o ' <br /> (.� (J �f m m <br /> ADDRESS V 1 l _ O A L t�l` <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> 1 <br /> LEGAL DESCRIPTION (see tax receipt) //_ <br /> CONTRACTOR V.J" <br /> TYPE OF PERMIT( DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> / n c1 <br />/ SANITARY /K RIW FILLING/GRADING CAMPING UNIT S BDIVISION <br />{ T� S <br /> STRtI E/ADDITION USE: <br /> SAM I7�C, AfOD 2) kill W-fn _R o r <br /> (Home/Cabin;Commercial Business; Bedroo ;Deck;etc.) z o <br /> 0 0 <br /> m <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). 0 <br /> 3. Show dimensions infeet of thefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building 1A I� <br /> measurement to the ordinary high water mark of lake, stream,or river. Q <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and a <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. In N <br /> C <br /> 2 fJ <br /> PLOT PLAN n o o <br /> coed <br /> � w <br /> l <br /> rn <br /> oJ <br /> N O <br /> O C <br /> O <br /> 'J� Z <br /> V <br /> rcDi a0 � <br /> m — 2.a0. am. m <br /> CONDITIONS OF PERMIT. < m'E Z 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o £ ''z - <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N <br /> !nn <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ^ 1O 0 : m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o : !f <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- f N m N m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a pemtil. 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 n p <br /> access to the above described premises at any reasonable time for the purpose of inspection. T 3 'oo <br /> m 9 A N <br /> O : <br /> SIGN HERE � ' <br /> N <br /> (signs re of owner r uildin contract i -(date 0 : <br /> o : <br /> ZONING ADMINISTRATOR - - - i $ <br /> N Nd1NN '*1 <br /> TOWNSHIP PERMITS MAY BE REOUIRED o A �� 8 m <br /> b $r$ $ $ $ N <br />