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eft C'ornq:�) <br /> Burnett Bounty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> d o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c <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. y m <br /> w � <br /> c <br /> O <br /> OWNER TELEPHONE n £ <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER 7 ?9 ROAD NAME t7�rS L!�t v Kd r G <br /> LEGAL DESCRIPTION (see tax receipt) ) <br /> CONTRACTOR 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARA /ACCESSORY STRUCTURE ADDITION o n <br /> n L] <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <° <br /> STRUCTURE/ADDITION USE: OA Y/,r` A e— <br /> (Home/C in;Commercial Business; Bedroom;Deck;etc.) Z o <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 the well (W),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions infeet ofthefollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)building .1 <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 -- <br /> dated by the owner. C o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a m <br /> 1I Z Q <br /> PLOT PLAN n o a <br /> m o <br /> C <br /> a <br /> M w <br /> a _ <br /> k <br /> I N <br /> N <br /> o <br /> m CM w 90 a :E m <br /> m i ,� 2.c,i � m � <br /> c m3.[ 6' c ' 3 <br /> CONDITIONS OF PERMIT: N .2 �' ro <br /> 13 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 1-d - <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _� ' 33 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> € N m <br /> o : ijD <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- 0 m <br /> lion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- a p <br /> mation I am providing will be relied 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- N <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above dcribed Dremises at any reasonable time for the purpose of inspection. p <br /> T m S m <br /> N <br /> SIGN <br /> (signature of owner or building contractor) (date) <br /> o <br /> ZONING ADMINISTRATOR : 0 : <br /> 4. <br /> N N W N N N N T <br /> TOWNSHIP PERMITS MAY BE REOUIREDIn <br /> u N u u o m <br /> oS000000 (A <br />