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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator (co A o I o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and z w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the mOC <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. o <br /> N d <br /> c <br /> OWNER <br /> C1 1'"/S1� r�I�O.Y LI I< -w TELEPHONE �3 � <br /> F <br /> O � <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER I ROAD NAME <br /> l <br /> 'l <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR / <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE 'V/ ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o o L <br /> Na <br /> STRUCTURE/ADDITION USE: V� � I ;L 5 � o O <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Zo <br /> O a <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). o <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. O o <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED 0 w <br /> PLOT PLAN n o a <br /> so <br /> °' fn <br /> 0 <br /> �3 t <br /> C) o <br /> N <br /> O , ty <br /> V1 <br /> b <br /> y <br /> N Yn�/lvV\' <br /> C) 01fr- T w� t�^� <br /> I <br /> Z <br /> 2-d ACVC 6 �6fx��� d f <br /> Ao' a n <br /> CONDITIONS OF PERMIT: a m <ar . m C m o 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F ar ? T 0 0 , <br /> 2 REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. E `: O n E O <br /> g c <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my know[- <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informa w m fn <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 8 <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 w <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O N p <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 8 8 <br /> m H <br /> c q q M <br /> SIGN HERE Cir d / / _ I �— «r <br /> (sign i owqekorbuilding contractor) <br /> i o <br /> ZONING ADMINISTRATOR I 5g <br /> TOWNSHIP PERMITS MAY BE REQUIREDN 'o o S m <br /> 88888 8802 <br />