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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> d O <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and H <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 Ordinar ce,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wiscon in. 3a') _ 8059Z m - <br /> N <br /> n O <br /> OWNER /1 TELEPHONE r`_S 3 <br /> ADDRESS -2If A4 , REDERIC WV S m <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> v <br /> LEGAL DESCRIPTION (see tax recei t) <br /> CONTRACTOR r� <br /> TYPE OF PERMIT(S): DWELLING/B JILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> ^X� n 0 <br /> 1 — <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> y r <br /> STRUCTURE/ADDITION USE: ° o <br /> ( ome/Cabin;Commercial Business; Bedroom; Deck; etc.) z o <br /> o� ` <br /> DIRECTIONS FOR PLOT PLANDRAWING: (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 I (W),septic tank (ST), and drainfteld (DF). <br /> 3. Show dimensions infeet of th efollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)building <br /> measurement to the ordina high water mark of lake,stream,or river. 0 <br /> 4. If separate plans are submitt d 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. 24 a m <br /> c <br /> Z v <br /> PLOT PLAN ° n <br /> fn o 0 <br /> . ':'� <br /> 1KA C M w <br /> M <br /> M <br /> 0 <br /> h <br /> N <br /> O V <br /> 7 <br /> 7 <br /> N <br /> Z <br /> i >7 <br /> rPd S'4nlf �ermi <br /> me y�io n a0 <br /> c g� � ao-i cm y <br /> CONDITIONS OF PERMIT: <, m 2 `� ro <br /> 1. DRIVEWAY MUST MEET D IVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F o LIQ ;b-1 2. REMOVAL OR CUTTING O TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. r. ", =r^ : M <br /> m : L)2 :o; m <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. n <br /> $: � C <br /> I declare that this application(in luding any accompanying schedule)has been examined by me and to the best of my knowl- o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- »y er m <br /> tion contained in this applicatio (including any accompanying schedule)and I further declare that I recognize that this infor' O <br /> mation I am providing will be r lied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I i <br /> further accept all liability which nay be a result of the County of Burnett relying on this information 1 am providing in this so- <br /> plication.I agree to permit tour y officials charged with administering county ordinances or other authorized person to have n N o <br /> access to the above described iremises at any reasonable time for the purpose of inspection. „ 3 b R <br /> m <br /> SIGN HERE (dale) <br /> QQ ' x <br /> ZONING ADMINISTRATOR [ <br /> »+NN`Jf N �Rl e,, m <br /> TOWNSHIP PERMITS MAY BE REQUIRED m <br /> o e v u <br /> $ $ $ ' $'� ma fA <br /> ua <br /> 0 <br />