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ffi7 eorr <br /> BWnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator S � f <br /> APPLICATION FOR — LAND USE — PERMITS m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q u <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the $ C>C3 <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. w m :�A <br /> w g <br /> I n O <br /> OWNER // Q� CI TELEPHONE <br /> [[[www [[[�cccccccc rl , <br /> m <br /> ADDRESS <br /> Orlh-S <br /> ,'h <br /> EMERGENCY/FIRE NUMBER )�E0, ROAD NAMEIf J9 <br /> LEGAL DESCRIPTION (see tax receipt) a-3 /_ ll�SL[ A)f— <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p ` <br /> n C) <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION o` o rt� <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <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). or, <br /> 3. Show dimensions in feet ofthe 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 2 <br /> dated by the owner. C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on o ur <br /> PLOT PLAN qZ S <br /> C I 1 <br /> f8 <br /> 4 <br /> m <br /> Z- <br /> 0 <br /> N � ' <br /> VV A' <br /> m <br /> �• o <br /> Qtr n <br /> yv Cc y� aC, <br /> io —g� '•aio am m <br /> CONDITIONS OF PERMIT: < .2T <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 0 m � <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. c ' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` �' ` Q m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- r1i o i - g = C <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informa- «w�"; m <br /> tion contained in this a • tion(including any accompanying schedule)and I further declare that I recognize that this infor- p <br /> mation I am providin will relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. $� $ <br /> further accept all lia lity whi h me be a rec�ged <br /> of theCounty of Burnett relying on this information I am providing in this ap- <br /> plication.I agree to permit c my fficiala h administering county ordinances or other authorized person to haveaccess to the abov descri misea re nable time for the purpose of Inspection. 0/ <br /> T <br /> m <br /> SIGN HERE E <br /> M: <br /> (signature of owner or building contractor) <br /> ZONING ADMINISTRATOR E g <br /> TOWNSHIP PERMITS MAY BE REOUIRED A,2 3 M j �� o~4n' $NANN S5 m <br /> `, 88888888 to <br />