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Burnett Courity 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m a o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and i <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c <br /> m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 � 10 <br /> regulations of the State of Wisconsin. - <br /> N d <br /> w m <br /> m O <br /> OWNER f J� TELEPHONELTD <br /> ��� �`'I a E <br /> ADDRESS 0 <br /> _ <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 p <br /> n G) <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> STRUCTURE/ADDITION USE: ^ I nW4 'Wo k6 �,L,)fali'V6 o ° <br /> Hom abin;Com ercial Business;Bedroom; Deck;etc.) Z m <br /> o ° <br /> v <br /> m <br /> } <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 ofthefollowing:(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. G <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. C o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a ur <br /> c <br /> PLOT PLAN o a <br /> o <br /> Ml <br /> Q . <br /> 0 <br /> � N <br /> ° <br /> � o <br /> N <br /> O -y <br /> �J <br /> Z <br /> IXC <br /> O c N r n n O y <br /> CONDITIONS OF PERMIT: o m_. ,z C ro <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o m� T = 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> N: 32 m <br /> ia <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. o m C <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 y>: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this info'r- V nl o ; p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o� o ' <br /> 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 a - ' <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. T 3 0 <br /> A H <br /> SIGN HERE <br /> (sign tura of o r buil n r) ( a <br /> Jill <br /> ZONING ADMINISTRATOR <br /> tnw u+� d.Fnw 71 <br /> TOW SHIP PERMITS MAY BE REOUIR o N N N N N m <br /> 000 0000 <br />