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Burnett County 7410 Co. Od. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3_ <br /> o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> 1 it <br /> located as shown herein. The u idersigned agrees that all work shall be done in accordance with the requirements of the m4 <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. N <br /> N � <br /> OWNER '\ TELEPHONE n E <br /> O <br /> ADDRESS Al 5 m <br /> , <br /> EMERGENCY/FIRE NUMBER ROADNAMENAME <br /> LEGAL DESCRIPTION (see taxret ipb ho CS V <br /> CONTRACTOR 'ewr oQ bgrrcisR m <br /> O <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a ° <br /> p " r <br /> STRUCTURE/ADDITION USE: 0 -' I(\ <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z <br /> 0 0 <br /> DIRECTIONS FOR PLOT PLA14 DRAWING: (Aerial or top view) <br /> 1. Show Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). I <br /> 2. Show the location of thew II (W),septic tank (ST),and drainfield (DF). o f <br /> 3. Show dimensions In feet of thefollowing:(a)buildingtoalllotlines,(b)buildingtocenterlineofroad,(c)building <br /> measurement to the ordinay 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. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a m <br /> PLOT PLANo <br /> i7..ti a c 0 <br /> Aa <br /> m o <br /> o <br /> See I o <br /> v <br /> cc <br /> p <br /> � n>; 0afm <br /> CONDITIONS OF PERMIT: m ,2 <br /> 1. DRIVEWAY MUST MEET I RIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o £ SI ' �� -q <br /> 2. REMOVAL OR CUTTING F TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. i _T. 3f <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o i 6 2 : m <br /> o : g2 . IDID <br /> I declare that this application(i icluding any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,corre t and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informa- <br /> tion contained in this applicati n(including any accompanying schedule)and I further declare that I recognize that this infor- 8 !9 o , <br /> mation I am providing will be elied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability whict 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 haveO N 6: <br /> access to the above described premises at any reasonable time for thp purpose of inspection. T 3 0p <br /> A W <br /> G <br /> SIGN HERI If - — v.; $ <br /> ( natu of ow r bund g ontraetor) j f` ! 1 1; ( atel 8 . <br /> ZONING ADMINISTRATOR •, : g <br /> OCT 15 :`'93 <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N N N m <br /> 1 7 b000000N <br />