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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m c c <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 3 <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws andUO <br /> _ <br /> regulations of the State of Wisconsin. w m <br /> w m <br /> a./ c <br /> OWNER /M� i/Z TELEPHONE a <br /> zv✓ o ' <br /> ADDRESS .706 2AJb Sr, / ) maIM/6_5 141A, <br /> EMERGENCY/FIRE NUMBER ROADNAME pa1mbe4,C4 D2 . <br /> I <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR f� <br /> TYPE OF PE MIT S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDNISIONo <br /> o <br /> 0'^ r �J <br /> STRUCTURE/ADDITION USE: o ° <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ZO <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or tap view) 00 <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 (yi),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 <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and X <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1fI o N <br /> PLOT PLAN o a <br /> In <br /> c , ' <br /> a <br /> I <br /> O <br /> J <br /> N <br /> O <br /> 0 <br /> x) <br /> 2 <br /> 1 <br /> Z <br /> 1 <br /> II•,_v\ <br /> O -. 0 O n OD- F m <br /> M <br /> CONDITIONS OF PERMIT: a o 3M <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Zo °'Z : i "I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. o M E E <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. - Yn G) O <br /> ro a i E C <br /> application(including Yaccompanying 1 Y Y C a ' <br /> I declare that this lication Includin an schedule has been examined b me and to the best of m knowl- o o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- - <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- In <br /> ? g n i <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 ; go g <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 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. ' m <br /> A <br /> 8 x <br /> A : ; <br /> SIGN HERE <br /> (Signet of owner or bu co ort/ (date) P <br /> ZONING ADMINISTRATOR <br /> wig- r <br /> TOWNSHIP ERMITS MAY BE REQUIRED ° o o m <br /> 88$8 <br /> fill <br />