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m dwyl <br /> Burnett Cafnty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ( m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme s of the 0 $ <br /> Burnett County Lard Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State of Wisconsin, w m <br /> u m <br /> c O <br /> OWNER O C _ <br /> m ^ m <br /> ADDRESS l WYom ��-- <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> Ctwwry <br /> LEGAL DESCRIPTION (see tax receipt)S LIOp O <br /> MW 56 )JZOT <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE ADDITION o O <br /> m <br /> SANITARY PRIVY)E FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> a <br /> o < <br /> N <br /> STRUCTURE/ADDrrION USE: ° <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) z o <br /> P o _ <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 dralnfield (DF). g <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. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on c <br /> KEN <br /> 1A Z c <br /> PLOT PLAN ° a <br /> J <br /> N � <br /> O y <br /> gyp' <br /> NB = Nrx �Ir �I <br /> Q) Ma X . :.� R e4v'at <br /> 1*1 36" <br /> 2- <br /> yg� �aw mm <br /> v a Z;: C g <br /> CONDITIONS OF PERMIT: ,-P . <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH RE EMENTS WITHIN 60 DAYS O ERMIT ISSU E. -.2 3 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEG ION IS RESTRICTED ALONG SHORELINE. f -_cpy m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS E ALLOWED UNLESS SPECIFICALLY PERMITTED. 25 `: <br /> E C <br /> I declare that this application(including any aceom nyinq schedule)has been examined by me and to the best of my kno <br /> edge and belief it is true,correct and complete.1 nowledge that I am responsible for the detail and accuracy of 11 inform '., ~ j s, m <br /> lion contained in this application(including any companylnq schedule)and I further declare that I recognize the this into T: O <br /> motion I am providing will be relied upon by th County of Burnett Wisconsin in determining whether to issue it. <br /> $ <br /> further accept all liability which may be, result the County of Burnett relying on this information I am providing in this a <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized pars on to hay O'E ; <br /> access to the above described promises at any reasonable time for the purpose of inspection.MAY <br /> ; 3 <br /> SKIN HERE A3L9 I <br /> (signature of owner or building contractor) (date) <br /> -5 : <br /> ZONING ADMINISTRATOR I: g <br /> TOWNSHIP PERMITS MAY BE REOUIRED o H u 8 N�irA iS m <br /> 8 8 8 18'8 to <br />