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0 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U) m c c <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q w 6 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. H a <br /> m <br /> OWNERUl1Lt•1 J �� I�� TELEPHONE ?ct ei <br /> ll�� J f m <br /> ADDRESS S, M_l L 6 m <br /> EMERGENCY/FIRE NUMBER S�� g ROAD NAME <br /> LEGAL DESCRIPTION (seetaxreceipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWE-LLING/BUIL—DING GARAGE/ACCESSORY STRUCTURE J,-'- ADDITION p <br /> n o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> �j `, m O <br /> STRUCTURE/ADDITION USE: ` , h� ] C� y..,)�jJ o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z ° <br /> 0 0 <br /> 0 <br /> m <br /> a <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 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 X <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1111 c q <br /> PLOT PLAN o n <br /> m J <br /> � r <br /> � I <br /> �cre �, cep o <br /> N <br /> O <br /> o <br /> v; <br /> I Z <br /> 1 � y D m (n V (/fir D Dp <br /> CONDITIONS OF PERMIT: g m c m o S K <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F a.a ? T' <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. G53 <br /> i C <br /> g [ : of <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl . o m `� 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- a w m <br /> lion contained in this application(including any accompanying schedule)and 1 further declare that I recognize that this infor- : 8 m u <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ m $ <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 <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 $ <br /> 3 a <br /> SIGN HERE—�5(l�Er,•f � 'L� /1 �� l Ti " " N $ <br /> (slgnatua of owner or building contractor) (date) <br /> 20NING ADMINISTRATOR )Int <br /> TOWNSHIP PERMITS MAY BE REOUIRED <br /> u mtno . o . m <br /> $ $ $ $ $ $ m <br />