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Burnett CopRty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o a <br /> APPLICATION FOR LAND USE — PERMITS 3. 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m O <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 0 C <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and n <br /> regulations of the State of Wisconsin , ! <br /> g �wt,"r r ". - <br /> _ m' <br /> OWNER II.�t� E <br /> 'd�((� O <br /> /)lig m <br /> �)�/t Mc P10N 16,11L TELEPHONE n <br /> • m <br /> ADDRESS J17 L5,- HENNFI AV. FoRgSr LK, tjAl . 55025 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> O <br /> SANITARY 7>� °PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 1< o <br /> STRUCTURE/ADDITION USE: o ° <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z m <br /> ° ° <br /> D <br /> N <br /> 3 <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). UJ <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). l (((���� <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. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. <br /> 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 9I a rn <br /> c - <br /> PLOT PLAN A o of el <br /> m o <br /> C <br /> mSO <br /> n <br /> N <br /> O <br /> 7 n <br /> b <br /> O � <br /> m <br /> Z <br /> lflffl"///iii S <br /> M <br /> mD �c Gi rDa � m <br /> m_ .ay c = 31 <br /> CONDITIONS OF PERMIT: w ,z CS <br /> 0 ro <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN r>D DAYS OF PERMIT ISSUANCE. o F 0 <br /> 2, REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> aL C_ <br /> 1 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- 9 " u m w M <br /> lion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- ,`a B g p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 'off o <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 S O N o <br /> access to the above described premises at any reasonable time for the purpose of inspe ' <br /> m m <br /> c $ <br /> jj�rJUN SIGN HEREign tura of owner or building contractor) (date24 ` <br /> ZONING ADMINISTRATOR I " "`'� <br /> R. <br /> rn ur w rn T <br /> TOWNSHIP PERMITS MAY BE REOUIRE o N u N N m <br /> ___-_ _ Rog ggoo N <br />