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efu <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator V ' o 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3. - <br /> m 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <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. w <br /> m <br /> m O <br /> OWNER Ah©"d �a� TELEPHONE <br /> ADDRESS <br /> d'30go jh1 j o <br /> �y I r�f1 �t� <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> -1 <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR rain -. ` ,t f 4P14az) T <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o —�L— <br /> X n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION, o` c ` V` <br /> m r <br /> STRUCTURE/ADDITION USE: o <br /> v <br /> (Noma/Cabin;Commercial Business; Bedroom;Deck;etc.) 0 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). I r <br /> 2. Show the location of the well (W),septic tank (ST),and dralnfield (D17. ° <br /> 3. Show dimensions in feet of the 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. Q <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. <br /> 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. <br /> 7I 2 0 <br /> PLOT PLAN Q 6 a <br /> m m <br /> C <br /> VIP a <br /> 1 � <br /> 0 <br /> N <br /> '-' <br /> o � <br /> IGS, <br /> �J <br /> I D_ <br /> I� <br /> D bit tn�m r DD 0 -0 <br /> ripe 33 WW a m p m <br /> m <br /> CONDITIONS OF PERMIT: a < y.j Q c 8 03 ,3 r. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 5 � <br /> : � i - <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. QQ� =T: ' 33 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 'T< �" ' L7 a"' m <br /> ��1177 �E !'€ O <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- y m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- u v 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- <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. ? 3 0 <br /> SIGN HERE N -~ <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED 'o m <br /> ogo g ) (/1 <br /> M <br /> 0 <br />