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o �* / <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3. <br /> m O <br /> TO THE ZONING ADMINISTRA R:The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein. The ui idersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordine nce, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisco isin. y <br /> w m <br /> c <br /> OWNER �L r „1e1 TELEPHONE �' Q �m'/S CP� o <br /> ADDRESS ei WW It r --T04(4 0" "�JQe <br /> tD 1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME I LT <br /> LEGAL DESCRIPTION (see taxrec ipt) <br /> CONTRACTOR <br /> 1 <br /> TYPE OF PERMIT(S): DWELLING/ lUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p v <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION 0 ° <br /> `^ r <br /> STRUCTURE/ADDITION USE: o 0 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) Z v <br /> o ° <br /> o <br /> m <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 thew II (W),septic tank (ST), and drainfield (DF). 0 <br /> 3. Show dimensions in feet oft ie following:(a)building to all lot lines,(b)building to center line of road,(c)building -q <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 <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 71 o rn <br /> 11 .Z `v <br /> PLOT PLAN o n <br /> Sc �Cf�P� CS1�L c � <br /> w <br /> m <br /> o <br /> /Vr J /J <br /> 1 <br /> r N <br /> n <br /> 0 <br /> N <br /> O <br /> 7 <br /> 2 y <br /> N <br /> 7 Z <br /> i 4{DN/_N11, <br /> 1 <br /> C <br /> m 2nm = m <br /> 0 _ S7 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET D IVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 0 <br /> 2. REMOVAL OR CUTTING O TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =Ner <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o a Oe o O <br /> R: ` C <br /> I declare that this application(it cluding any accompanying schedule)has been examined by me and to the best of my knowl- o <br /> edge and belief it is true,correc and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- igp <br /> mation I am providing will be r lied upon by the County of Burnett Wisconsin in determining whether to issue a permit. $`8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am provitling in this ap- d, <br /> plication. I agree to permit cou ty officials charged with administering county ordinances or other authorized person to have O m 0 <br /> access to the above described Dremises at any reasonable time for the purpose of inspection. ' 0 ' e <br /> m 3g : <br /> � 0 � <br /> F :O <br /> SIGN HERE '`' <br /> (signature of owner or building contractor) (date) � <br /> N <br /> ZONING ADMINISTRATOR g : x <br /> NM6fYk i91.K � <br /> TOWNSHIP PERMITS MAY BE REOUIREO o �H' '� m <br /> 000 � o��i i� N <br /> a» <br /> 0 <br />