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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator rn M z <br /> m m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 'Z e <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the M C <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. o <br /> / 6i 3/� �.i✓ 2 w ` m <br /> OWNER y /. / TELEPHONE //, 7 r7{ '7C7� /r /2'4, a f <br /> ADDRESS / DC7- /ilejUE <br /> EMERGENCY/FIRE NUMBER ROAD NAME r1 <br /> I <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> PE OF PERMITS. FEEING/BUILDING GARAGE/ACCESS STRUCTURE ADDITION p <br /> SANITARY P FILLING/GRADING CAMPING UNIT SUBDIVISION r^ o <br /> V o <br /> /— tl1 r <br /> STRUCTURE/ADDITION USE: \ T j�C (n IT o o <br /> (Home/Cabin;Comme ial Bus ness;Bedroom; Dec etc.) Z M <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) �1 <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 the following:(a) bulldingto all lot lines,(b)building to center line of road,(c)building .1 (' <br /> measurement to the ordinary high water mark of lake,stream,or river. O <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. A M <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSRE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 0 c w <br /> PLOT PLAN n Z c <br /> m y <br /> C ' <br /> ) <br /> M <br /> 0 <br /> N <br /> O <br /> J <br /> J �) <br /> O y <br /> N <br /> w <br /> 0 <br /> Z <br /> Z <br /> J <br /> C <br /> 0 o c �. m 0 . a m <br /> CONDITIONS OF PERMIT: a mff °' c <br /> 7. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F vi ? z 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. T ' : M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �+ Yrn ': [ Gt O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- g m m D <br /> m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- w m e, <br /> lion 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 8T 8 <br /> further accept all liability which may be suit of the County of Burnett relying on this information I am providing in this ap- <br /> plication. I agree to permcounty offi Is charged with administering county ordinances or other authorized person to have O p <br /> access to the above d c e pre <br /> as at ap reasonable time for the purpose of inspection. 8 <br /> T <br /> LM : M <br /> SIGN HERE "� 7C -97— <br /> (signature of owner or building contracto (det4) <br /> ZONING ADMINISTRATOR �/ J L.. - i g <br /> TOWNSHIP PE ITS MAY BE REQUIRED JUP,I 2 19 `" " 8 `" 8 8 rn <br /> NNOtNli00 m <br /> 8 $ 8 $ $ 8vm, <br />