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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872Office of Zoning Administrator m o 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> TO THE ZONING AD <br /> MINISTRA OR:The undersigned hereby makes " - 4 <br /> 9 Y application for r Permit for the work described and 'z w <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 Gude, and with all other applicable County Ordinances and the laws and 3 n U <br /> regulations of the State of Wiscc instn. - \ <br /> 0 <br /> H � <br /> OWNER �l �C� _ TELEPHONE a O <br /> GJ O £ <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAM a <br /> LEGAL DESCRIPTION (see tax receipt) J <br /> 0 <br /> CONTRACTOR G2 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> 0 <br /> SANITARY <br /> PRIVY-- FILLING/GRADING CAMPING UNIT SUBDIVISION n o r <br /> 0 <br /> STRUCTURE/ADDITION USE: G IU(yta ,.Ct -J SC`tSc7n, �U I`a°s g <br /> (Home/Cabin;Commercial Business; Bed om;Deck;etc.) <br /> 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 thew II (W),septic tank (ST), and drainfield (DF). o <br /> 3. Show dimensions in feet oft efollowing:(a)building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordinar r high water mark of lake,stream, or river. 0 <br /> 4. If separate plans are submit ed by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. O <br /> 0 <br /> NOTE; BUILDING/STRUCTURE LODTIONS MUST BE STAKED FOR ONSrFE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '1I 3 y <br /> PLOT PLAN I1 G �'I TO {v'�U� S' (/Grttyi¢ o n <br /> C lQicJt'1 ( fl C �"+`7e— a <br /> PC <br /> i 2 <br /> kAn GRconl <br /> Z 2 F o I� 1�p <br /> 3° p�° s <br /> Q <br /> f; n <br /> a 0 r <br /> Z <br /> Id' °ot <br /> 15' 70 r75zl m -g ' a m a :E m <br /> CONDITIONS OF PERMIT: C <br /> 1. DRIVEWAY MUST MEET DRI EWAY WIDTH REQUIREMENTS WITHIN 60 YS OF PERMIT ISSUANCE. c 0 �8 5 M <br /> � <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N <br /> 3, NO GRADING OR SHORELA qD ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N: i 2 i m <br /> 0 ; B O <br /> I declare that this application(inc uding any accompanying schedule)has been examined by me and to the best of my know(- 0 <br /> edge and belief it is true,correct nd complete.I acknowledge that I am responsible for the detail and accuracy of all informs- (W., " •e m n� m <br /> tion contained in this application including any accompanying schedule)and I further declare that I recognize that this infor. N g o ; p <br /> mation I am providing will be rel i d upon by the County of Burnett Wisconsin in determining whether to issue a permit. o <br /> further accept all liability which rY ay 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 On�i <br /> po: <br /> access to the above described pr mises at any reasonable time for the purpose of inspection. <br /> m m0 ' <br /> SIGN HERE <br /> 0 : <br /> (si tur of owner tiding contractor) date <br /> ZONING ADMINISTRA1101 <br /> TOR �- <br /> g <br /> TOWNSHIP PERMITS MAY BE REQUIRED o N N N N N m <br /> 0000 $ 000 () <br />