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cane f <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Admin+strator m m e 0 <br /> APPLICATION FOR — LAND USE — PERMITS >< — <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work descr bed and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremei its of the <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the aws and <br /> regulations of the State of Wisconsin. m <br /> OWNER TELEPHONE n £ <br /> lv� J: J o <br /> ��1 m <br /> ADDRESS 5`j O • �1/ t !1J ri�yQ <br /> EMERGENCY/FIRE NUMBER _ C ROAD NAME ) �� <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR rT� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION - p <br /> i <br /> rt, <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION oo 4C. - <br /> � <br /> y r <br /> �-� 3 - -f ���1c , , L <br /> STRUCTURElADDITION USE: � � o fl � <br /> (Home/Cabin;Commercial Business;Bedroom;De ;etc.) <br /> Z ° <br /> 3 <br /> J <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 Nort i (N). J <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF), o <br /> 3. Show dimensions In feet of thefoliowing:(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 all ned and �.^I <br /> dated by the owner. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE GSUED. 7I o y <br /> PLOT PLAN o $ <br /> �l1 I n <br /> / N 4-- <br /> 71 <br /> -7 c , <br /> m <br /> CONDITIONS OF PERMIT: 6 0,w 4 m <br /> '- yZ€ eCSga � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. , =N <br /> i aa <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m ;: ' L m <br /> QQ <br /> E <br /> � O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of y knowl- J O C_ <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 w <br /> tion contained In this application(including any accompanying schedule)and I further declare that I recognize that his infor- c $ <br /> motion 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- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have m <br /> access to the above described promises at any reasonable time for the purpose of inspection. <br /> O m '2 ` ` <br /> SIGN HERE <br /> ! [ •+ <br /> (signature or building contractor) (date) � <br /> ZONING ADMINISTRATOR J� <br /> TOWNSHIP P MITS MAY BE REQUIRED o N li <br /> S5 v u, N i5 rn <br /> -88888888 UP <br />