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vit <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator S m f a <br /> APPLICATION FOR — LAND USE — PERMITS m a <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and .2 w r� <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremer Is of the .✓-� <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the I ws and _ <br /> regulations of the State of Wisconsin./a Imes �7 w m <br /> w o <br /> c <br /> OWNER /J fLTELEPHONE y6 *77G <br /> ADDRESS ✓ -•J y +7 O L. /i L �J <br /> J yG� <br /> EMERGENCY/FIRE NUMBER ROAD NAME / (l /� <br /> ellC t <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR gad a L /-ti 6A,*- <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p 3 <br /> n V7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> N <br /> STRUCTURE/ADDITION USE: Y i 4 o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> m W <br /> } <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 Nort i (N). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DIF). I 5 <br /> 3. Show dimensions In feet of thefoliowing:(a) building to all lot lines,(b)building to center line of road,(c)building j <br /> measurement to the ordinary high water mark of lake,stream,or river. V <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be all;ned and d^ <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSFE VERIFICATION BEFORE A PERMIT CAN BE GSUED. 7I 3 N <br /> PLOT PLAN n o n <br /> O <br /> 0 1 , <br /> 0 <br /> m <br /> a �l <br /> r I� <br /> Z <br /> � s <br /> s <br /> (D-0 DDO -0 <br /> f <br /> e z. 9 <br /> CONUiTIONS OF PERMIT: v z:, Q CS g,E r.1. DRNE'WAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c m' 74 <br /> 2. REMOVAL OP CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. F^„ 9 0 i XI <br /> m <br /> 3. NO GRADING OP SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �i p <br /> i E <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- i N a m <br /> tion contained In this application(including any accompanying schedule)and I further declare that I recognize that this infor- B p <br /> malion 1 am providing will be rolled upon by the County of Burnett Wisconsin in determining whether to issue 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.I agree to permit countyOfflciats charged with administering county ordinances or other authorized peraDn to have [ 0: 0: <br /> access to the above described premises at any reasonable time for the purpose of inspection. ° e (ef E <br /> m <br /> m m <br /> SIGN HERE <br /> (slgnatu of owner r builds g c n r to ate) <br /> ZONING ADMINISTRATOR _ 8 <br /> - NN+�NMN� <br /> TOWNSHIP RMITS AY BE REQUIRED > 8 N N 8 'Mn <br /> $ 8 $ $$ 888 vi <br />