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Burnett County 7410 Co. Rd. K. No. 102, Siren, WI 54872 Office of Zoning Administrator m : c c <br /> APPLICATION FOR - LAND USE - PERMITS . <br /> TO THE ZONING ADMINISTRATOR:The undersigned here (� <br /> rsig by makes application for a Permit for the work described and a �v <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the require ms of the <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and a <br /> regulations of the State of Wisconsin. <br /> in m° <br /> w <br /> c <br /> OWNER q4--f L[l/ TELEPHONE � l/_ (/ n !� F <br /> ADDRESS x74/ r rS f <br /> a <br /> EMERGENCY/FIRE NUMBER ROAD NAME IAi i <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR �l <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o o \ <br /> 0 <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) (l <br /> Z o <br /> a o _ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 4� <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate No h (N). <br /> 2. Show the location of the well (N),septic tank (ST),and dreinf(eld (DF). <br /> 3. Show dimensions In feet of the following:(a) building to all lot lines,(b)building to center line of road,( )building 14 —0 <br /> measurement to the ordinary high water mark of lake,stream,or river. IIS' <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be s gned and <br /> dated by the owner. O <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 71 3 y <br /> PLOT PLAN z cc <br /> o v <br /> C M m <br /> to I <br /> C71 I� <br /> I <br /> O rn <br /> R0 <br /> J ° <br /> o N <br /> m <br /> i I <br /> 2 <br /> G <br /> m <br /> CONDITIONS OF PERMIT: v m 3: Z c M g <br /> 1. DRIVEWAY MUST MELT DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m' Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. :` g m <br /> k ` O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of y knovil- o : ' C <br /> edge and belief it is true,correct and Complete.I acknowledge that I am responsible for the detail and accuracy of a I informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- m <br /> g <br /> : v <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue j i permit. I i i <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing n this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized persontoltarve <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> CD $ E <br /> m <br /> SIGN HERE <br /> (signature of owner o Du Idin r t (date) w <br /> ZONING ADMINISTRATOR $ <br /> TOWNSNI MITS MAY BE REQUIRED <br /> � iX 4X £Sm <br /> 88 8888 vm) <br />