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Ct <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator N, m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3_ <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the '^ m <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. 5 m <br /> m Q� _ TELEPHONE �t,OWNER o E <br /> ' <br /> { / ` �/ P f p,/ m m <br /> ADDRESS 33'34 Sw Zr..F..�4 u✓cod [.�1� 9J G�'ttii �U, I sy To <br /> EMERGENCY/FIRE NUMBER ROAD NAME �'i- •- _ r .� ` , <br /> LEGAL DESCRIPTION (see tax receipt) 1 t <br /> [� i�1- t <br /> CONTRACTOR rel <br /> ivl`r1 <br /> TYPE OF PERMIT(S). DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> O. <br /> O y <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> r = <br /> STRUCTURE/ADDITION USE: ° <br /> Ho / bin;Commercial Business; Bedroom; Deck;etc.) Z o <br /> 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 (Vi), septic tank (ST),and drainfield (DF). <br /> 3. Show dimensions infeet ofthefollowing:(a)building to all lot lines,(b)buildingto center line of road,(c)building a <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 M <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 v rn <br /> 71 Z e `Q <br /> PLOT PLAN p a <br /> C t <br /> 1 <br /> d mUs <br /> LK tel, <br /> ° <br /> J_ <br /> J <br /> 0 Iy� <br /> ° � I <br /> Z <br /> _ � I <br /> m �c��rtDia� � <br /> CONDITIONS OF PERMIT: < K: Q C .8 m C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e F T'z : '-1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o ; i al0° <br /> o : nffi <br /> C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- .°�. : m G : <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informa. a w m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 1 <br /> oration I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $`� $ <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 <br /> plication.I agr to permit county officials charged with administering county ordinances or other authorized person to have O N o <br /> access to the ve descri d pr raises at any reasonable time for the purpose of inspection. 'n ? 3 o RL i <br /> m A N <br /> SIGN HERE 2 <br /> date) ` <br /> (signature otowner or uildin ontractor) ( Q,j o x <br /> ZONING ADMINISTRATOR // ' I���1 8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N N W <br /> 00 <br /> 0SBPP <br />