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64&_4. <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Admini trator m m o <br /> OZ <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work tlescri d and .2 o <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirement 3 of the ' w <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the la s and <br /> regulations of the State of Wisconsin. m <br /> w � <br /> OWNER -�1 k I I TELEPHONE n f <br /> o m <br /> m <br /> ADDRESS m <br /> EMERGENCY/FIRE NUMBER 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� ° <br /> J <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) V Z <br /> 0 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). 5 <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. 0 <br /> 4. It separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. 0 S <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE UED. 7I 3 N <br /> PLOT PLAN o 'n <br /> n s <br /> � o <br /> C <br /> 0 Co <br /> I <br /> 0 C <br /> J <br /> r <br /> 0 _V ter, <br /> J U 1 <br /> A\ r ~ <br /> QwNer eS- k_ofi Li CS r1 h16 <br /> �J <br /> GNFCCA4�aj 4� 13 d-."tiksf 19,5 a Ua I qsi P� y8/ � �7 <br /> m <br /> e D L e c >7 <br /> CONDITIONS OF PERMIT: < w i `Z C g O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z o o: Z : -1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p F J y >> <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. i 7 i O ; 1 m <br /> of <br /> i IL i toC <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- E o : i E M <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informa- : N m N : rh <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that 1 lis infor- 1 i R B p <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I i i $ $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing is this ap- i ' <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have i E O i 0 <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> m m w <br /> N N <br /> SIGN HERE <br /> (sl et oto r building contractor) (date) <br /> ZONING ADMINISTRATOR �` ' $ <br /> TOWNSHIP PERMITS MAY BE REQUIRED JO N N N N N N N M <br /> N lSR " 8 m <br /> 88 $ $8888 umi <br />