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N ( , <br /> .t County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o, o <br /> APPLICATION FOR - LAND USE - PERMITS 3. <br /> 'HE ZONING ADMINISTRATOR:The undersigned herebymak s application for a Permit for the work described and w <br /> „ated as shown herein. The undersigned agrees that all work all be done in accordance with the requirements of the m <br /> durnett County Land Use Grdinance,Sanitation Code, and wit all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisnsin. ,� m <br /> m <br /> OWNER EL I TELEPHONE <br /> ti RL 0 <br /> n (6 FO <br /> ADDRESS Chi A LC71 h -IM RS M <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) v <br /> `4 — <br /> CONTRACTOR i f U <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION v_ o <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> STRUCTURE/ADDITION USE: ° o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z m <br /> 0 0 <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 11. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). rd <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). <br /> 3. Show dimensions in feet of the 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. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 'A <br /> dated by the owner. o - <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. T a N - <br /> 71 Z cv <br /> PLOT PLANA 0 n (' <br /> m �^ <br /> N0 <br /> t <br /> ' S L 1ti7 e LJ 1� <br /> U; <br /> Z <br /> u��v 11 <br /> 2 <br /> me irDaO � <br /> m pS� 2. c0 am <br /> CONDITIONS OF PERMIT. ^ H Z C$ 0 m <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o �'z q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =y i M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o 13 C <br /> g'E : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o i <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- i : •n m a M <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infon a o ; p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. i $`I3 $ <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- y, <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have N m <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 $ <br /> Q A 0 <br /> OINAI <br /> SIGN HERE <br /> (signature of owner or building contractor) D (date) a' <br /> o . =: E <br /> VING ADMINISTRATOR g <br /> TOWNSHIP PERMITS MAY BE REOUIRE I ---- o m N m <br /> o g o goo N <br />