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N e. <br /> Burnett County 1410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and H <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 Od <br /> regulations of the State of Wisconsin. N <br /> ... OWNER 006 aS OXT d �l le TELEPHONE <br /> Q m 1/ <br /> P3ESS ��./ � <br /> RGENCY/FIRE NUMBER 3� a ROAD NAME —G/t. /P/ Q/ 1 <br /> _EGAL DESCRIPTION (see tax receipt) I �� � }A jT ��W/� <br /> CONTRACTOR Y , <br /> (t <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> L1 <br /> n <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVI o °< <br /> r <br /> STRUCTURE/ADDITION USE: ✓Mf,tt' i�� n i �Jl tiT L <br /> (Home Cabtin;Commercial Busi s; Bedroom;Deck;etc.) o B <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRA a r t view) <br /> 1. Show the location and size of all existing buildi gs (EB) and all new buildings (NB) and Indicate North (N). <br /> r <br /> 2. Show the location of the well (W),septic tank ( T),and drainfield (DF). g <br /> 3. Show dimensions in feet of the following:(a)bu ' g to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordinary hi0fi water mark of lake,str'Pam,or river. 0 <br /> 4. If separate plans are submitted'by an architect,engineer,builder,contractor,etr.. the Tans must be signed and <br /> owner. <br /> NOTE: BUIbLDINGeSTRUCTURE LOCATIONS '1 / / 0 3 <br /> ONS M STAKED-FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ED. on p m <br /> c <br /> PLOT PLAN P a <br /> C OS <br /> a <br /> o <br /> 0 lob <br /> o <br /> _ <br /> rn <br /> 7�Qy �cDi 0. aO IT <br /> CONDITIONS OF PERMIT. / f' ` %• a < m' Z C8 So T+ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. ,: ",I o <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ,, f w' [ w E M <br /> 62 m <br /> 3, NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. - Sf b [ a m ' D <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- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o b <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am Providing in this - .n <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have O p <br /> access to the above described premises at any reasonable time for the purpose of inspection. r 3 00 <br /> A m <br /> 4,1 <br /> �eo� g c:act <br /> M � <br /> SIGN HERE (sign reo ownr (date) <br /> 0 : <br /> og <br /> ; <br /> ZONING ADMINISTRATOR E <br /> N <br /> TOWNSHIP PERMAY BE REQUIRED N W . <br /> N <br /> O <br /> m <br /> ommomm0000go0 <br />