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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator C�� ! 'z <br /> APPLICATION FOR — LAND USE — PERMITS m m <br /> 3 _ <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. o <br /> m <br /> OWNER C;titi,5 Witzany TELEPHONE (715) 689-2720 a m EO <br /> ADDRESSp U. Box 39 GAan;Atbmg, WI 54840 <br /> EMERGENCY/FIRE NUMBER ROADNAME Little. Wood Large VAT.Ve , <br /> LEGAL DESCRIPTION (see taxreceipQ CQ.. 0� ?and in G.L. 6, Section 25, T38N,R18W, Town o{ <br /> CONTRACTOR Woo Rtveh <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> SANITARY X PRIVYFILLING/GRADING CAMPING UNITSUBDIVISION 0 o (J <br /> 0 <br /> STRUCTURE/ADDITION USE: SanitaAU U:a.2/e `� r <br /> o ° <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z v <br /> Oo <br /> v <br /> m <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). o <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 <br /> dated by the owner. 9 M <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. o ur <br /> PLOT PLAN a S <br /> H <br /> m o <br /> C ' <br /> a <br /> m <br /> m <br /> 0 <br /> SEE ATTACHED I a <br /> m <br /> 70 <br /> o � <br /> N <br /> r Al <br /> l� <br /> Z <br /> I � <br /> G <br /> r�V»rnr D DOS <br /> c a <br /> . 6 a m m <br /> CONDITIONS OF PERMIT: c M;2.. R w v— 9 <br /> < v; Z c8 pro +_T <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m o. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. e :E 1 :: 21 m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. i N 62 m <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. iC <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- —+ (n y. <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. C ii B o m <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 o <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 agree to permit county officials charged with administering county ordinances or other authorized person to have O N o <br /> access to the above described premises at any reasonable time for the purpose of inspection [ mom <br /> SIGN HERE W <br /> o <br /> (signature of o r buil c ntrI�� r`�' <br /> ZONING ADMINISTRATOR - 0 <br /> loN �w� m <br /> TOW HIP PERMITS MAY BE REQUIRED N V�-- u <br /> 0 0 o o N <br />