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�� <br /> Burnett County 7410 Co. Ad. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d 0 0 <br /> APPLI ATION 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 i <br /> m c <br /> located as shown herein. The u idersigned 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 andLA <br /> _ <br /> regulations of the State of Wisconsin, H m <br /> w ,p <br /> c <br /> OWNER �: TELEPHONE&,5-6_-�Q/JO n f <br /> m_ iD <br /> ADDRESS <br /> �S <br /> EMERGENCY/FIRE NUMBER 9 ROAD N E <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTORG� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n 0 ISANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> ZY <br /> m r <br /> STRUCTURE/ADDITION USE: o g <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) z <br /> 0 0 <br /> m <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 thew ll (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 <br /> measurement to the ordinai y high water mark of lake, stream, or river. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. in o O .i <br /> 11 z c <br /> PLOT PLAN S'QP lcl� U n P, a <br /> C <br /> ( <br /> M <br /> w <br /> AlgdyD�'f� <br /> W <br /> 0 <br /> O� 4A1 <br /> 9 n <br /> ! 7 � D <br /> BNoa <br /> CONDITIONS OF PERMIT: Z C8 0. <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PER ISSUANCE. e T <br /> 2. REMOVAL OR CUTTING F TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ - >7 <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O k oa)2 � Q <br /> o <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- (\' 0 <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- ' m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- i i B p <br /> mation I am providing will be r slied upon by the County of Burnett Wisconsin in determining whether to issue a 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 cour ty officialcharged with administering county ordinances or other authorized person to have N p <br /> access to the above ascribed pre es at an reasonable time for the purpose of inspection. p <br /> m a 8 'mg va <br /> SIGN HERE <br /> (81, <br /> siowner or but in contractor) r— {decal- i H ' <br /> pi <br /> ZONING ADMINI RATOR _ <br /> x ` <br /> I I) H M Y <br /> TOWNSHIP PER ITS MAY BE REQUIR m <br /> oo $ eo o � &` U) <br /> x x x x <br /> F- <br /> I � <br /> 0 <br />