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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54072 Office of Zoning Administrator d m a o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and c ,� <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m _ <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. m m <br /> c <br /> n O <br /> OWNER41�" N 7_ TELEPHONE6-- LllM f <br /> q m_ <br /> ADDRESS 54$93 m <br /> J <br /> EMERGENCY/FIRE NUMBER ROAD NAME t <br /> ti <br /> LEGAL DESCRIPTION (see tax rec ipt) CD <br /> 1^ <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o � <br /> n O <br /> SANITARY_ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> o m <br /> � tU <br /> N � <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z vo <br /> o a <br /> DIRECTIONS FOR PLOT PLA14 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 ell (W),septic tank (ST),and drainfield (DF). <br /> 3. Show dimensions infeet of hefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building -q I ,� <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a to <br /> 71 Z Q <br /> PLOT PLAN <br /> nP - <br /> fn <br /> a <br /> c � ' <br /> i <br /> _. <br /> o <br /> s c� <br /> y <br /> IC <br /> 7Q MZ <br /> I <br /> c ui r-Da0 <br /> CONDITIONS OF PERMIT: ^ Q C S g.n' T+_ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. -Q -j <br /> - <br /> o F <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N <br /> 3, NO GRADING OR SHORE LAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 'No E a-)o p <br /> 0: <br /> I declare that this application(ncluding any accompanying schedule)has been examined by me and to the best of my knowl- o : m <br /> edge and belief it is true,corre t and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- _ i ia y H m <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. 1 o <br /> further accept all liability whic i 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 COL my officials charged with administering county ordinances or other authorized person to have O <br /> access to the above describec premises at any reasonable time for the purpose of inspection. 3 bo E <br /> A m <br /> IT— <br /> SIGN HERE I i�� `- .`- I,.. - <br /> 1 F (date) ! f <br /> Fri i <br /> ZONING ADMINISTRATOR r ru <br /> E E E S E [ <br /> TOWNSHIP PERMITS MAY BE REQUIRE :i W M d o ul <br /> ! o ,uNiN Baa' N m <br /> 000 060 . 00 <br />