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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator (Aa c <br /> APPLICATION FOR — LAND USE — PERMITS 3. 3. <br /> m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <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. ' ^ • N o <br /> OWNERV1=F1l,TELEPHONE n v <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER S'a 7 4� ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) CD <br /> CONTRACTOR Z' SON S <br /> (� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY_', PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o <br /> STRUCTURE/ADDITION USE: j/&99?' --s[} - AbUt-O 110-117E o 4 �-- <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) <br /> Z o <br /> 0 0 <br /> m <br /> 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). Il�� <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 0 <br /> dated by the owner. o <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSfTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. <br /> PLOT PLAN Z <br /> a <br /> m o <br /> In <br /> a <br /> M <br /> W <br /> IF <br /> 0 <br /> m <br /> 0 <br /> z <br /> z <br /> �1 <br /> p In ff» Nr DD <br /> mo c m m n d g <br /> m am a M <br /> CONDITIONS OF PERMIT3 <br /> , v < m H <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 0 ! 42Tam - ? <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. �+� m C <br /> 8 : c : <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o : m `� 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- <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 . . a 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- iI <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have o <br /> access to the above described premises at any reason le time for the purpose of inspection. 8 $ <br /> T n a <br /> r A [ A <br /> SIGN HERE <br /> a <br /> (si nature of owner or buildin o recto (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED N o a e m <br /> 88 9999m, <br />