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0711) <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 11 0u ' 0 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3 <br /> 0 <br /> TO THE, '.ONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <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 a <br /> regulations of the State of Wisconsin. H m <br /> w � <br /> c <br /> OWNER6rM]] TELEPHONE <br /> ADDRESS f�D. L,y / 67/CLLD(><''R WI• ✓r/l//� `v <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> I � . <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR r <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION o <br /> n L) <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> J — <br /> ,n � <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z <br /> }oma 0 <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 of thefollowing:(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. 0 <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 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSfTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a m <br /> c <br /> Z Q <br /> PLOT PLAN o a <br /> C <br /> •� <br /> In �� <br /> G <br /> N <br /> J <br /> N I�y <br /> O 1 <br /> J <br /> J <br /> n �) <br /> N Z <br /> I <br /> c ui a F m <br /> Lk0 <br /> D m <br /> CONDITIONS OF PERMIT: ^ y' Z T�' =ro <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o <br /> 2, REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N <br /> mi G) <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o n _ 0 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- i 0 : <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- � g ; m <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 oo <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this a <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have n N p <br /> access to the above described premises at any reasonable time for the purpose of inspection. „ 3 obP, <br /> M � O <br /> SIGN HERE 9t— _ ? HB i <br /> (signatur of owner or buildi con to - <br /> ZONING ADMINISTRATOR �r P <br /> TOWNSHI RMITS MAY BE REOUIRED O N N V N N m <br /> � o00 H8.10 <br />