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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> IV OZ <br /> APPLICATION FOR — LAND USE — PERMITS <br /> d <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work desci ibed and w r <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme s of the $ <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. d <br /> m <br /> G� m O <br /> OWNER ��� < TELEPHONE <br /> + �lfc ,I_ JGe m <br /> ADDRESS IbLiI u u .�'ls C� �� L&Z- �)-V7 1 - <br /> EMERGENCY/FIRE NUMBER ROAD NAME (� <br /> i <br /> LEGAL DESCRIPTION (see tax receipt) c. -f- <br /> �) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o ` <br /> G1 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT� SUBDIVISION o ° <br /> STRUCTURE/ADDITION USE: <br /> v <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) o <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 Noi th (N). I r <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). S <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,( )building <br /> measurement to the ordinary high water mark of lake,stream,or river. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be s Igned and <br /> dated by the owner. Q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. <br /> 11 z `o <br /> PLOT PLAN J <br /> L < <br /> 0 <br /> 0 <br /> c <br /> L- - M <br /> _ <br /> m <br /> o <br /> IJJ <br /> Z <br /> f <br /> v Dg� '-Bam m M <br /> CONDITIONS OF PERMIT: CS g r. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. of - M <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - y' '• O <br /> M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> Qq L <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- ` o , d. N i <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy fall informs- m m <br /> don contained in this application(including any accompanying schedule)and I further declare that I recognize t at this infor- ' <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to las e a permit. $ $ <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 pi Pinion to have ? O: og <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE <br /> (slgnatu%ner or building contractor) (date <br /> E E <br /> ZONING ADMINISTRATOR / `'}/ ` g <br /> wMw.2 7 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o !n . is 4) .. .. . a <br /> $ 8888888a <br />