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} <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m <br /> C-0 v z <br /> APPLICATION FOR - LAND USE - PERMITS m 3. <br /> f o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m o <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the A c <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. <br /> v <br /> OWNERc�c;y�, _� %�..� F.;✓ TELEPHONES <br /> m m <br /> ADDRESS — - f / "" `� / " }�n _ m e <br /> EMERGENCY/FIRE NUMBER , <br /> ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o o <br /> 0 <br /> STRUCTURE!ADDITION USE: o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z v <br /> 0 0 <br /> a <br /> 3 <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 /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). o <br /> 3. Show dimensions in feet of the following:(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. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 3 N <br /> PLOT PLAN z Q <br /> o 0 <br /> M <br /> 0 <br /> C l ' <br /> m � z <br /> "C tl ou <br /> .c <br /> N <br /> J� <br /> Midi b° C))f / EE110 N o <br /> O <br /> // ////-�� <br /> S,S b� `70 <br /> 2a LoT <br /> S ern /S i d-� <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F a ? r� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. f"n O O <br /> g : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my know) o fD � i m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa w m w : O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- .b" N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 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- <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O 0 0 <br /> access to the above d scribed premises at an easonable time for the purpose of inspection. m 8 R <br /> In <br /> CJ <br /> SIGN HERE <br /> gnatse of owner or building contractor) date)' <br /> ZONING ADMINISTRATOR / )T )IGifM/ � � 8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED i +, 1 <br /> 0 oo � m <br /> -$ S� 88 �88v, <br />