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6P CDY+, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator S o f c <br /> APPLICATION FOR - LAND USE - PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes m " g <br /> 9 by application for a Permit for the work described and w I <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c ✓1 <br /> Burnett County Land Use Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and 3 <br /> regulations Of the State of Wisconsin. <br /> w m <br /> w � <br /> OWNER �nG <br /> ADDRESS <br /> TELEPHONE (�I; 'l \ n O <br /> D\ �� VVVV"''�� <br /> (1�} vv WT S `I �O m <br /> EMERGENCY/FIRE NUMBER e ROAD NAME <br /> r <br /> LEGAL DESCRIPTION (sea tax receipt) �I <br /> CONTRACTOR ,wy, <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> SANITARY PRIVY FILLING/ RADING CAMPING UNIT SUBDIVISION o <br /> 0 <br /> STRUCTUREIADDITION USE: S,-,A , �. <br /> w <br /> O � <br /> (Home/Cabin;Comm 1 Business;Bedroom;Deck;etc.) <br /> 0 o <br /> O o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) Q/ 3 <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)buildingto center line of road,(clbuilding <br /> measurement to the ordinary high water mark of lake, stream, or river. " r <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sl ned and M <br /> dated by the owner. O 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTE VERIFICATION BEFORE A PERMIT CAN BE SSUED. c <br /> N <br /> PLOT PLAN 1A = c <br /> � o a <br /> M o <br /> C ' <br /> III <br /> j <br /> G_ <br /> s <br /> Jo <br /> m <br /> o <br /> w <br /> r <br /> O <br /> z <br /> �'� jm <br /> m <br /> FLv� – a <br /> CONDITIONS OF PERMIT: q 3:: Q c 8 gFS ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. z m <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. E ' ' _N: 33 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ' N i Gt G <br /> 1 declare that this application(including any accompanying schedule)has been examined b me and to the best of i <br /> C <br /> Y Y knows- ✓i , <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all Informs- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor B p <br /> matlon 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing i this t. I <br /> plication.1 pros to permit county officials charged with administering county ordinances or other authorized prose to have o <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE <br /> 1 <br /> (signature of ow or ufl f g ont oh (date) <br /> ZONING ADMINISTRATOR 8 <br /> TOWNSHIP PERMITS MAY BE REQUIREDm <br /> T <br /> 88 88 $8 ai <br />