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cc�n (04, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator a) o O <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> d o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and 3 0. <br /> regulations of the State of Wisconsin. rn m <br /> OWNERTELEPHONE <br /> �✓ o_ ' <br /> ADDRESS $037- 0PC-H1gk7 HV. /V • 9900 LV6l PR� IYA4 <br /> EMERGENCY//FIRE NUMBER ROAD NAME <br /> 1 lJ <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CC1� <br /> CONTRACTOR y <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> y/ <br /> SANITARY / PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o <br /> r T <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z 0 <br /> o ° <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> } <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 (Vi), septic tank (ST), and drainfield (DF). g <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. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. O a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a m <br /> 11 Z cv <br /> PLOT PLAN <br /> o n <br /> m o <br /> C ' <br /> (}wVD <br /> J <br /> N <br /> O <br /> r <br /> n <br /> N <br /> \ 2 <br /> )741 <br /> o'-ULn > >0 -0 <br /> c ..> j 0 a F m <br /> CONDITIONS OF PERMIT: <br /> .- 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E 1 <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. o 6 2 <br /> ID <br /> 2i i <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 2i iC <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- : •n a a, m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B o <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 oR o <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 O N p <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> 3 p tmf <br /> T V O N <br /> m m <br /> /a_ 3 N <br /> SIGN HERE <br /> (signatu of owner or buildin nt d OCT (date_)., <br /> ZONING ADMINISTRATOR _ <br /> TOWNSHIP PERMITS MAY BE REOUTAEb - �" �' N o o m <br />