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Arnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m -a o' az <br /> APPLICATION FOR - LAND USE - PERMITS -- <br /> m = <br /> FO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the CO <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. a m <br /> w m <br /> c <br /> OWNER ti (1,r-'Is TELEPHONE £O <br /> ADDRESS 4,le, Y' <br /> EMERGENCY/FIRE NUMBERa 74. ROAD NAME <br /> 1 <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> I <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> _ <br /> N <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z v <br /> 0 0 <br /> 0 <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 No Ith (N), <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). <br /> 0 <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,( )building 11 <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. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 0 v m <br /> PLOT PLAN Z c <br /> rr <br /> SaJ Lv' C 1� <br /> (!� N I <br /> G m <br /> L � <br /> o �I <br /> m <br /> S <br /> V O <br /> 2 <br /> / D <br /> 2S9, (0 7 <br /> Tia --- <br /> MM <br /> CONDITIONS OF PERMIT: v m g Z c g 9- <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e f <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - ` N S <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N i m <br /> g � ; O <br /> PP (including Yaccompanying 1 Y y o E C <br /> I declare that this application Includin an schedule has been examined b me and to the best o m knowl- o i <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of ill informs- C, «a w <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize the t this infor- �' d ? m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providin in this ap- <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized pe n to have mOi o <br /> access to the abov descri remises at any reasonable time for the purpose of inspection. <br /> m -2 ! <br /> SIGN HER 7 S S <br /> '� a <br /> (signature of owner or building contractor) (date) Wi <br /> w` <br /> ZONING ADMINISTRATOR + i_ `«ca -{�� .' r/� ` <br /> A: $ <br /> TOWNSHIP PERMITS MAY BE REQUIRED I o N g N m <br /> 88 $ $8 $ w <br />