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07t ��' <br /> Burnett County Y410 Co. R . K, No. 102, Siren, WI 54872 Office of Zoning Administrator m 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3' <br /> m 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and y <br /> located as shown herein. The un Jersigned agrees that all work shail be done in accordance with the requirements of the m C\ <br /> Burnett County Land Use Ordinalice, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a �- <br /> regulations of the State of Wisco sin. y d ! <br /> w � � <br /> OWNER u �_� 1)U&-, J TELEPHONE b J - ,Jbc) o J O <br /> m <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME ` <br /> C� <br /> LEGAL DESCRIPTION (see tax receipt) (` L <br /> CONTRACTOR <br /> h' <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O <br /> SANITARY _ PPRIVYo FILLING/GRADING CAMPING UNIT SUBDIVISION� o J <br /> STRUCTURE/ADDITION USE: <br /> Home/Cabin;Commercial Business;Bedroom;Deck;eta) Z o v <br /> v <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 North (N). <br /> r <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). 0 <br /> 3. Show dimensions in feet ofthe following:(a) building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordinar.r high water mark of lake,stream, or river. Q <br /> 4. If separate plans are submitl ed by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOOTIONS MUST BE STAKED FOR ONSfTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on rn <br /> 11 Z `v <br /> PLOT PLAN <br /> 111 x <' o <br /> 0 <br /> V. <br /> J C�V <br /> N <br /> n <br /> :x <br /> o <br /> N <br /> G <br /> m c 0 r n a O <br /> m. pS� jE <br /> 6 o'-m l <br /> CONDITIONS OF PERMIT: o <,m': 1 C S ro r. <br /> 1. DRIVEWAY MUST MEET D IVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o <br /> 2. REMOVAL OR CUTTING Cz TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =Nin: 9 <br /> H <br /> 3. NO GRADING OR SHOREI,AND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o n o' D <br /> o : a2i <br /> I declare that this application(i cluding any accompanying schedule)has been examined by me and to the best of my knowl- C <br /> edge and belief it is true,correc and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- T <br /> tion contained in this applicati n(including any accompanying schedule)and I further declare that I recognize that this infor- 12 <br /> B p <br /> mation I am providing will be f ailed upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 p` ' <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 cou ty officials charged with administering county ordinances or other authorized person to have i ; ON o en <br /> access to the above described remises at any reasonable time for the purpose of inspection. .n ; 3 $ 0 <br /> N V N a <br /> m b <br /> N N <br /> ty: a, ' <br /> (signature of owner or building contractor) <br /> SIGN HERE <br /> (date) <br /> ZONING ADMINISTRATOR <br /> D x X X <br /> TOWNSHIP PERMITS MAY BE REQUIRED o N m <br /> o000 0oo ® o'>$ ® ® N <br /> x x x <br /> to <br /> 0 <br />