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Burnett Couhty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 5 $E c <br /> APPLICATION FOR — LAND USE — PERMITS m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v v J <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 _ <br /> regulations of the State of Wisconsin. <br /> OWNER f f\�{1�J { <br /> r1 I I(S Can7e4 — / TELEPHONE �) E <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> 4 , <br /> CONTRACTOR bane �- <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION_ j <br /> o <br /> a � <br /> STRUCTURE/ADDITION USE: 0 2 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z v <br /> 0 0 l <br /> m <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size of all existing buildings (ES) and all new buildings (NB) and indicate North (N). <br /> 2. Show the location of the well (V ),septic tank (ST),and drainfield (OF). <br /> 3. Show dimensions In feet of thefollowing:(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. C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 v to <br /> PLOT PLAN o S <br /> � w <br /> G3- las <br /> 0 <br /> 0 <br /> 0 <br /> m <br /> o <br /> N <br /> l <br /> 'Lo_ <br /> � Fila <br /> v _ c ff <br /> CONDITIONS OF PERMIT: �' s <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Zi i 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �' ` <br /> C C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this Infor- <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I 8 g <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- p « <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 promisee at any reasonable time for the purpose of Inspection. <br /> E <br /> SIGN HERE « ` 3 <br /> (signature of owner or building contractod (date) g '• <br /> ZONING ADMINISTRATOR E E <br /> «« m <br /> TOWNSHIP PERMITS MAY BE REQUIRED '0 4Y k% {)+ ' 2 u`I m <br /> $ $ 88$ 8 $ 8Pn <br />