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C so <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> m ° <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v 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 n <br /> regulations of the State of Wisconsin. N m <br /> w � <br /> m J O <br /> OWNER- / U I ey-!�(� �( L?, TELEPHONE <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER 51'-kn,1 o ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> ° o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a <br /> w C <br /> STRUCTURE/ADDITION USE: S \ w G P I6w�Z / X �, / ° <br /> m <br /> (Noma/Cabin;C mmercieI Business; Bedroom;Deck;etc.) Z o <br /> a a <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 the well (W),septic tank (ST),and drainfield (DF). ° <br /> 3. Show dimensions in feet ofthefollowing:(a)building to all lot lines,(b)building to center lineof road,(c)building <br /> measurement to the ordinary high water mark of lake,stream,or river. Q '— <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. Q o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. o <br /> N <br /> c <br /> PLOT PLAN <br /> 0 Q <br /> �I � n <br /> A <br /> Z-1m w <br /> c <br /> -- ' (- <br /> ° �J_I <br /> L a <br /> i lea <br /> lod o ¢mIT <br /> IT <br /> 2. o.= A <br /> CONDITIONS F PERMIT: c < Q rB T+ <br /> 1. DRIVEWAY 11ST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYA OF PERMIT ISSUANCE. o �Q 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. - Ti i O 2 i m <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 1 am responsible for the detail and accuracy of all informs- t m d. <br /> L7 <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 $ <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 N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. T 3 -oo <br /> 0 <br /> w <br /> SIGN HERE <br /> (signature of owner or burl g co r to ate <br /> ZONING ADMINISTRATOR $ i <br /> ru. . . 8bo <br /> smTOWNS P ERMITS MAY BE REQUIRED UI tn N N 8 uJ m <br /> $ $ rm <br /> pp <br />