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crq <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m 'ac 0 <br /> APPLICATION FOR — LAND USE — PERMITS '- >< <br /> m = <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w ° <br /> located as Shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. 1 a <br /> OWNER TELEPHONE f --��I �IR< < n O <br /> THE RT S - T.CROW COUNCIL E <br /> — b a = <br /> ADDRESS 'P.O, $D 'LS? u <br /> S`>`$ <br /> EMERGENCY/FIRE NUMBER ROAD NAME r.. <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> SANITARY�_ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo o — <br /> STRUCTURE/ADDITION USE: 1 1 �� I j ,^ 1p (Y- 0 ((j <br /> o 0 <br /> (Home/Cabin;Com_ ercial Business; Bedroom;Deck;etc.) Z <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> } U� <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 0 <br /> 3. Showdimenslons Infest of thefollowing:(a) buildingto all lot lines,(b)buildingto center line of road,(c)building G <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 9 <br /> dated by the owner. ii CN <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on v m <br /> PLOT PLAN c g <br /> H ' <br /> t� y <br /> O <br /> C <br /> G <br /> o % <br /> D <br /> co <br /> 8 <br /> O <br /> _ <br /> m <br /> O y <br /> 2 <br /> I � <br /> F <br /> g X' <br /> e. i£� -FL4 2. <br /> a <br /> _ � m <br /> CONDITIONS OF PERMIT: '2 g�;; C <br /> < Zig <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c f <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m <br /> � �il' : ` C <br /> PP (including Yaccompanying 1 Y - <br /> I declare that this application Includin an schedule has been examined b me and to the best of m knowl- i/1F 4 : 33edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all Informs- <br /> tion <br /> forma-tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- is B ,�' ? p <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 1 am providing in this ap- <br /> plication.I agree t0 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 ina . <br /> T <br /> SIGN HERE - <br /> APR T""TI <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIREDm <br /> w <br />