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W co)lyp <br /> Bu mett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U m o c <br /> APPLICATION FOR — LAND USE — PERMITS £ <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � v —L-- <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. w m <br /> OWNER DQ /) q I I� r+ ��TELEPHONE <br /> C G m A <br /> ADDRESS PA k& <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> O it <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> J <br /> QI N T <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z <br /> 0 0 <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 (N),septic tank (ST),and drainfield (DIF). <br /> 3. Show dimensions Infest 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. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sl ned and <br /> dated by the owner. <br /> 00 <br /> NOTE: BUILDINGISTRUCTURE y6cATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I 3 N <br /> PLOT PLAN Z <br /> o n <br /> C <br /> .S o <br /> - <br /> Cr <br /> �� <br /> N W <br /> 0 <br /> IC✓2 e0 <br /> 0/ <br /> CV Al {n et t�las 10 <br /> �U <br /> OA ess C.1 ll <br /> 9 DOA <br /> CONDITIONS OF PERMIT: .. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <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. - ZS E J E <br /> O <br /> i : i E �i C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of y knowl`- ; 9 <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informal ro , m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infOr y.} p <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 s E <br /> access to the above described premises at any reasonable time for the purpose of inspection. j <br /> v i <br /> SIGN HER <br /> (signature"nor or building contractor) (date) <br /> ZONING ADMINISTRATOR �n N NSM N O N N N <br /> Sm <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> N N <br /> o N N <br /> 888 $$$ $$ vmi <br />