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Burnett Couhty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Admin strator in 'a E c <br /> APPLICATION FOR — LAND USE — PERMITS - <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work desci bed and ' v <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme s of the 0 $ <br /> Burnett County band Use Ordinance.Sanitation Code, and with all other applicable County Ordinances and the aws and <br /> regulations of the State of Wisconsin. a m n <br /> m m <br /> OWNERG,Gfh ✓ TELEPHONE [ , E <br /> ADDRESS 2 7q q 7c. �N V M. Q. C I 7' m A <br /> EMERGENCY/FIRE NUMBER ROAD NAME 71 <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> o < <br /> _ <br /> m � <br /> STRUCTURE/ADDITION USE: $ <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) v <br /> z o <br /> 0 v <br /> m <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 (yi),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions In feet ofthe 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. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 2 <br /> dated by the owner. 0 a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE UED. 4% a <br /> PLOT PLAN 11 o <br /> n ' <br /> m o <br /> C a� <br /> C) s <br /> N <br /> O <br /> I}= <br /> N <br /> O <br /> _ <br /> 1 <br /> O y <br /> N I�\`✓ <br /> M <br /> F <br /> 1 <br /> c� <br /> G <br /> -C m <br /> g4 <br /> CONDITIONS OF PERMIT: D a w �_ <br /> m' s'€ ? �� g' <br /> Z 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REOUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. F : • - <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. o = i <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED.' '• V7 '• m <br /> Er I <br /> Eri <br /> 1 declare that this application(Including any accompanying schedule)has been examined by me and to the best of ny knowl- i2. ' #i `• C <br /> edge and belief it is true,correct and Complete.I acknowledge that I am responsible for the detail and accuracy of a I informs. i E •m T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that his infor- <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue permit. 1i 84 $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing n this ap- <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have ' <br /> access to the above dewfibed promises at any reasonable time for the purpose of inspection. <br /> -n <br /> SIGN HERE r" ' " J N - <br /> lal (date) <br /> ZONING ADMINISTRATOR S ? E <br /> TOWNSHIP PERMITS MAY BE REQUIRED , R N n g m <br /> 888888 ai <br />