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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator rn 'D -4 z <br /> `° ° 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w ° <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. <br /> 'o <br /> f w m <br /> c '3 <br /> OWNER ^Ct ^D/� �- TELEPHONE <br /> o <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER G1 ROAD NAME j ft <br /> LEGAL DESCRIPTION (see tax receipt) Zo� <br /> Z4/ L��� �C� �� �CONTRACTOR SB Y' <br /> `- <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNITSUBDIVISION ^ O <br /> o �- ` <br /> STRUCTURE/ADDITION USE: o 0 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z '9 <br /> 0 0 <br /> 0 <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 of thefollowing:(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. O <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. O O <br /> 0 <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on o <br /> PLOT PLAN z ` <br /> o n <br /> io/o m 0 <br /> m — <br /> C) <br /> MIN <br /> I � <br /> O <br /> l)� <br /> i <br /> Gt N <br /> Jam+ N <br /> n_ <br /> 0 <br /> N <br /> O <br /> n <br /> N <br /> n <br /> z <br /> Z <br /> u <br /> G <br /> � NN m (Ar ➢ D p � <br /> CONDITIONS OF PERMIT IteLQ: m Z6 Mm <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f � _ r� 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 71 m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Yrn 62 O <br /> m � C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- g 10 a <br /> m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informer m O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I m <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 <br /> access to the above described premises reasonable time for the purpose of inspection. 8 <br /> m A <br /> 0 m <br /> m <br /> SIGN HER <br /> signature of owner (ding ntr =' <br /> s <br /> o : <br /> ZONING ADMINISTRAT Z(date <br /> Ry7�eeL 8 <br /> TOWNSH P PERMITS MAY BE REQUIRED <br /> Nm1N0 (11000 m <br /> 88 $ 88P88rmn <br />