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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <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 requirements of the $ <br /> Burnett County Land Use Ordinance,Sanitation Cafe, and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State of Wisconsin. m <br /> DSK ke <br /> �i / O <br /> OWNER Wen aft r /sem TELEPHONE �/ 7�2 O je) C 0 J <br /> LJ / .7 7 6 m u A <br /> ADDRESS <br /> Lj 00 <br /> EMERGENCY/FIRE NUMBER 31F Jl�� ROAD NAME Webb LDY \ <br /> r� l <br /> LEGAL DESCRIPTION (sae tex receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o o <br /> STRUCTURE/ADDITION U O <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z a <br /> Cit I <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). <br /> 3. Show dimensions Infest 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. N separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and A <br /> dated by the owner. a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSRE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7i 3 N <br /> Z <br /> PLOT PLAN <br /> n <br /> C ) 0 <br /> y P� <br /> {:. ►� v Sa"ftsy�� Per n m ,� <br /> r <br /> Y x 7a O <br /> s <br /> m <br /> a <br /> o <br /> m <br /> i <br /> Z <br /> a <br /> 33 <br /> n <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. to 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. .Qe'i m <br /> �E : O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- F o� !i '• C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all infonna- [ e+m•^ T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- $ al 8 : p <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue 0 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.1 agree to permit county officials charged with administering county ordinances or other authorized person to have m`• <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 9 p a <br /> SIGN HERE L I - <br /> H; <br /> ( ignature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED (a rn <br /> N N O N N N O m <br /> $ 8 $ 8888$ of <br />