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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o I o <br /> APPLICATION FOR - LAND USE - PERMITS 3. <br /> m G <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 0m <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. w <br /> QQ c <br /> OWNER Dy� �ia�� TELEPHONE CP 3 <br /> ADDRESS -} 9oDs �ENz/t �w lei//f , } <br /> EMERGENCY/FIRE NUMBER 54Me / /1 ROAD NAME <br /> ' F�C� <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE X ADDITION oT <br /> SANITARY PRIVY0 FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> STRUCTURE/ADDITION USE: G LQ s1Ait <br /> o - <br /> (Home/Cabin;Commercial siness;Bedroom; Deck;etc.) Z <br /> 0 0 <br /> a <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 (OF). <br /> 3. Show dimensions in feet of thefollowing:(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. 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. in c N <br /> PLOT PLAN Z <br /> 0 <br /> M <br /> /L o / �G�/ c <br /> Nl •ca <br /> o i <br /> � r <br /> Q, n <br /> p o <br /> J <br /> N <br /> OM. <br /> J <br /> O I\\ y <br /> N <br /> n <br /> 2 <br /> Z <br /> ( <br /> D p m <br /> F m <br /> J J 0 a <br /> CONDITIONS OF PERMIT: 0 ,z a o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F a T� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. rDrt <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. E ro 2 i 0 <br /> 8 € io <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m m m <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- 8 m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 8 m 8 <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 O u, <br /> access to the abov esc bed premises at an reasonable time for the purpose of inspection. 0 g <br /> T 3 <br /> M 0 <br /> / ry <br /> SIGN HERE <br /> N : <br /> N <br /> (si u o o n bu' ing contractor) (date) 8 <br /> ZONING ADMINISTRATOR 8 <br /> TOWNSHIP PERMITS MAY BE REOUIRED o <br /> 8 N " " <br /> fn tnfnooiAi m <br /> 8888 $ $ 8 vi <br />