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1 <br /> Bumett County 7410 Co—Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d - 0 0 <br /> APPLICATION FOR - LAND USE - PERMITSTO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein. The un Jersigned agrees that all work shall be done in accordance with the requirements of the m m ,� <br /> Burnett County Land Use Ordinaiice,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a f <br /> regulations of the State of Wiscor sin. w m <br /> /,, m <br /> OWNER ��' TELEPHONE Kl35-- - o. i <br /> C75 m 1 m <br /> ADDRESS � ( �V - A: � �f� ���lJ'1• �n. � �L <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> I <br /> LEGAL DESCRIPTION (see tax race pt) <br /> CONTRACTOR i- - •— i— r� <br /> ct— <br /> TYPE OF PERMIT(S): DWELLING/ UILDING GA E/ACCESSORY STRUCTURE ADDITION o <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> m r ­ <br /> 0 <br /> STRUCTURE/ADDITION USE: °c <br /> Home/Cabin;Commercial Business; Bedroom; Deck;etc.) OZ o j <br /> a <br /> � L <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 we II (W), septic tank (ST), and drainfield (DF). a <br /> 3. Show dimensions infeet oft efollowing:(a)building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordirl high water mark of lake, stream, or river. Q <br /> 4. If separate plans are subM!tl ed by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. 0o <br /> NOTE: BUILDING/STRUCTURE LO TIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I 3 m <br /> 71 Z Q <br /> PLOT PLAN ° <br /> r <br /> m ,ir <br /> V. � { I ��� 1'- 1-70 <br /> 0 <br /> N <br /> 0 <br /> j <br /> b <br /> O y <br /> N <br /> J Z <br /> I � <br /> M a 0 r a O 9 <br /> m —g� � am cL0 <br /> 6' c'" r. s <br /> CONDITIONS OF PERMIT: o F ? �� ? i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING CF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N M <br /> o' i 62Pj m <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ^i p <br /> 0-2 i C <br /> I declare that this application(i eluding any accompanying schedule)has been examined by me and to the best of my knowl- o m l <br /> edge and belief it is true,correc and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- -�`: w 6" m <br /> tion contained in this applicati n(including any accompanying schedule)and I further declare that I recognize that this infor- (': ( B p <br /> mation I am providing will be lied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 $� <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing In this ap- <br /> plication.I agree to permit cour ty officials charged with administering county ordinances or other authorized person to have (II. : 0" 0 : <br /> [ <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> a e w <br /> N:ln <br /> SIGN HERE a i <br /> (si nature of owner or building contractor) (date) a' <br /> ZONING ADMINISTRATOR ``O'r' �'/^I' E i ' 8 i z <br /> xinMw n <br /> TOWNSHIP PERMITS MAY BE REQUIRED ffi a m <br /> ogo ® $ ' fA <br /> X <br /> 0 <br />