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�J U;) _ <br /> Burnett Cotr-rtty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m o c <br /> APPLICATION FOR - LAND USE - PERMITS2. 3. <br /> TO THE ZONING ADMINISTRATOR:The here undersigned g by makes application for a Permit for the work described and � c <br /> 17�- <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 n <br /> regulations of the State of Wisconsin. H o <br /> N <br /> C <br /> 9 <br /> r / n O <br /> OWNER.'Vdr /�$T L TELEPHONE G 3 S� -7 Z.d r if <br /> lam!/ <br /> G 'I <br /> ADDRESS/3DX ��/ l✓�J3 7 iQ /rf// r"!5, 3- <br /> EMERGENCY/FIRE NUMBER ROAD NAME ., <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTORt r'O <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION1` p <br /> ct <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> STRUCTURE/ADDITION USE: f <br /> (Home/Cabin;Commercial Business; Bedro m; Deck;etc.) ,r �i <br /> Z o <br /> a o <br /> } <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 in feet ofthefollowing:(a) building to all lot lines,(b)buildingto 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. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I c w <br /> PLOT PLAN S X171 ��5�� o a <br /> m o <br /> ct ' <br /> to s <br /> ,C w,gt/c oLD /�ciicD/.vtJ 3 5? y� I <br /> 1 <br /> N <br /> 0 <br /> o <br /> �2 <br /> ""PC)Tn <br /> r /oo <br /> -�- z <br /> m <br /> CONDITIONS OF PERMIT: <br /> c m Rd C o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 3 ? T = a <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. : L7 <br /> m M <br /> g : a <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- - o m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- tr` : <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I r $ m $ <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 <br /> access to the above described premises at any reasonable time for the purpose of inspection. °' 8 R <br /> ,mj V A H <br /> N a 8 <br /> SIGN HERE <br /> (si at r of"67Zneg lding contractor) (da 0) 8 x <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REOUIRED JUN6 I992 o o o m <br /> , . 8'8888888 a, <br />