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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o c <br /> APPLICATION FOR — LAND USE — PERMITS f <br /> TO THE ZONING ADMINISTRATOR:The undersigned by pp m <br /> tarsi ned here makes application for a Permit for the work described and rn <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m 0 <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n (Ji <br /> regul;of the State of Wi nsin.OWNt ' TELEPHONE � n <br /> ADDRESS ' ( (pur J <br /> r � C'0. � �n /C.�1 .5-46 <br /> l <br /> EMERGENCY/FIRE NUMBER ROAD NAME 'I <br /> LEGAL DESCRIPTION (see tax receipt) 7 \ <br /> CONTRACTOR / <br /> TYPE OF PERMIT(S): DW <br /> ELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p l <br /> m <br /> ct <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> r o` <br /> ° <br /> 0 r <br /> STRUCTURE/ADDITION USE: � L4'-) 0 0 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) I <br /> o ° <br /> a <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 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 -q <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 Q 1 <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED, 1I 3 rn <br /> PLOT PLANZ Q <br /> A o n <br /> M SOo <br /> C <br /> 1A <br /> m <br /> M <br /> M <br /> _ <br /> 0 <br /> m <br /> � a � <br /> N <br /> Z <br /> 1 z <br /> f <br /> 0 N r D D <br /> o c r m = g m <br /> CONDITIONS OF PERMIT: v m -c�' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o <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. V7n <br /> 8 : RE : C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m a 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. <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 8 ro N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 8 8 <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 in <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3g 2 <br /> j o A <br /> SIGN HERE OC <br /> (si atu of own building contract ---------date) <br /> _ <br /> c' n <br /> ZONING ADMINISTRATOR r� F-� �' <br /> TOWNSHIP PERMITS MAY BE REQUIRED '', '- o N 8 <br /> JUN 1 5 1992 88' <br /> 8 8 8 <br />