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Burnett Courilly 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m c c <br /> APPLICATION FOR — LAND USE — PERMITSs' <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements 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. w m <br /> c o <br /> "�� ` (� la- a a f <br /> OWNER -1>I aft we 1 TELEPHONE R (,�—�O <br /> ---111JJJ777 <br /> ADDRESS a3b�Z Lai_4 <br /> i <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOF/ _ r <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAG CCESSORY STRUCTURE ADDITION o <br /> L7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> 0 <br /> STRUCTURE/ADDITION USE: c <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z o <br /> o v <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) I ` <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). r <br /> 2. Show the location of the well (W),septic tank (ST), and dralnfield (DF). <br /> 3. Show dimensions in feet ofthe following:(a)building to all lot lines,(b)building to center line of road,i(c)building � I <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 signed and 9 <br /> dated by the owner. 0 3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '71 o N <br /> 1A Z o <br /> PLOT PLAN n ° <br /> M <br /> _,j <br /> o <br /> C ) � <br /> See- � ,�� CS t <br /> V , I �- ��3 <br /> o <br /> m <br /> o <br /> a <br /> r I0 <br /> Z <br /> I <br /> i• <br /> R 9 <br /> g. 9w: tae <br /> g <br /> CONDITIONS OF PERMIT: g. .i Q '� 's ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e ! �'Z : : 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. —N` '• =1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �" `• O ; C <br /> QQ �E : C <br /> i 5 <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs• «a «: Irl <br /> tion contained In this application(Including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I ; $ $ <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.1 agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of Inspection. T <br /> a <br /> w <br /> SIGN HERE <br /> (signature of owner or building contractor) (data) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED m <br /> m <br /> 888888$'8 rn <br />