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�r <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54372 Offiee of Zoning Administrator o f c <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q <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 Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and _ <br /> v <br /> regulations of the State of Wisconsin. w m <br /> c m <br /> 1 y TELEPHONE <br /> OWNER <br /> ADDRESS �3 �� `D��1S 1 J R _ m <br /> ' G "C <br /> EMERGENCY/FIRE NUMBER '3 ROAD NAME <br /> LEGAL DESCRIPTION (seetaxreceipt) PCI �G�Yy ISCyy�/� <br /> CONTRACTOR N -'� w <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n G1 (b <br /> SANITARY PRIVY Q�FILLING/GRADING r� CAMPING UNIT SUBDIVISION °- <br /> STRUCTURE/ADDITION USE: �`1 t'-�� �flTM%Y� �RZSS`'71' ��ex o - <br /> v <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 0 3 <br /> c <br /> ro <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 in feet of thefollowing:(a)buildingtoalllotlines,(b)buildingtocenterlineofroad,(c)bullding I <br /> measurement to the ordinary high water mark of lake,stream,or river. Q <br /> 4. B separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and A <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. z 0 <br /> PLOT PLAN <br /> Q) <br /> m <br /> � o <br /> N G = <br /> o <br /> G = <br /> m <br /> O y <br /> cy Z <br /> 2Y 1 <br /> (t�), I , � ,�)=�t <br /> g m <br /> CONDITIONS OF PERMIT: o E R _� ' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. to <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. 5 ' p <br /> �i <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- N o «O vs <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- ,_ of ,b, : m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> further accept all Iliing iabillityllwh be <br /> may be a result of the the Co ntyof Burnett Wisconsin in of Burnett relying on thiseinformat on I am providing inining whether to issue a pth this <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have o <br /> access to the above described premises at any reaso able time for the purpose of inspection. T 93 Q- <br /> m m <br /> SIGN HERE 1 ' (date) <br /> ($I at re of owner b ding contractor) <br /> ZONING ADMINISTRATOR ` ` 4 - - <br /> NMM�MM, <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />