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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o !o <br /> APPLICATION FOR - LAND USE - PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work de ribed and Q a CND <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the require me of the m = <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and th laws and $ <br /> regulations of the State of Wisconsin. <br /> 0 <br /> a m <br /> w <br /> c <br /> OWNERry u5CIV Q _ 2q71 o O <br /> TELEPHONE Fz4q3 - <br /> ADDRESS ' <br /> S SWOOD R- CT[A KR 0 Ig g <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tau receipt) <br /> r <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> 0 <br /> J » <br /> m <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin;Commercial Business; Bedroom; Dock;etc.) Z T <br /> o ° <br /> 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 No Ith (N). <br /> 2. Show the location of the well (W), septic tank (ST), and drainfleld (DF). <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. 04 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be a igned and 0 <br /> dated by the owner. 0 0 <br /> NOTE: BUILDINGSTRUCTURE LOCATIONS MUST BE STAKED FOR ONSfiE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 71 c y <br /> PLOT PLAN Z ° <br /> a <br /> C O n <br /> A c44t-:D <br /> cy G <br /> d <br /> r <br /> N <br /> O <br /> J <br /> N <br /> ° <br /> J <br /> m <br /> O � <br /> _a <br /> - � a <br /> -tf 6�63c-" �`" <br /> Z <br /> 1 <br /> e <br /> 2MIMI <br /> 33 <br /> CONDITIONS OF PERMIT: o m 3. c o g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> o fJ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O i m <br /> Lr E <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best 01 my knowl- o? !t C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of i kit informa- ' •"m"' T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize the this infor- `-b' it ,`a p <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I � `$ <br /> g 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providin In this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized pen on to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. ' <br /> SIGN HERE <br /> (date) w <br /> VING ADMINISTRATOR 8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> �� � N� m <br /> $ 88$$ 88 vmi <br />