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l <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator W 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 2 <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 w <br /> 0 <br /> regulations of the State of Wisconsin. w <br /> m <br /> . , . TELEPHONE A , L✓ND 70/ <br /> ADDRESS Q On Om <br /> IJL-, <br /> EMERGENCY/FIRE NUMBER 8 77— 1 C,y 2D v ROAD NAME C <br /> LUT Z c7JV iQr'M LNT {-oT 3 S0�rtoN 7-5) TO W A +v <br /> bwYD -� <br /> LEGAL DESCRIPTION (see taz receipt) NOR'fN t (ZAN6E 17 wESj $JP --r GoJNTy <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE�_ ADDITION O <br /> n 7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a °. <br /> 0 <br /> STRUCTURE/ADDITION USE: C74 RG A �/L� /� �C 7 o <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) oZ o <br /> 0 <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). ° <br /> 3. Show dimensions infeet of thefollowing:(a)building to all lot lines,(b)buildingto center line of road,(c)building <br /> measurement to the ordinary high water mark of lake,stream, or river. Q <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. Q o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on a N <br /> �I Z T <br /> PLOT PLAN Cc V N Ty RD U (� U� n <br /> C � o <br /> m � = <br /> M <br /> R <br /> m <br /> 16� o <br /> ' N a <br /> O I 3 yi <br /> 3 <br /> m <br /> _ O <br /> 1 y <br /> i Df 1 Q <br /> z <br /> 0 <br /> � c <br /> c 0 a f m <br /> L <br /> t I rte r Ya"Oki AX r- a y o> >o <br /> CONDITIONS OF PERMIT: ='° �'— <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F �� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =2 i i m <br /> in <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. '^ n <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- ° . m. m <br /> edge and belief it is true,correct and complete.1 acknowledge that 1 am responsible for the detail and accuracy of all informa- <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 $ <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 N o <br /> access to the above described premises at any re5ponable time for the purpose of inspection. <br /> N m N <br /> m : <br /> SIGN HERE <br /> (signatureI o wer or building contractor) (date) <br /> ZONING ADMINISTRATOR 'sd"T3 �uu <br /> d N N W N N N N m <br /> TOWNSHIP PERMITS MAY BE REQUIRED O N N U N U O <br /> M <br /> $ $ $ $ $ $ $ $ ip <br />