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i <br /> 1 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator z <br /> m m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS2. <br /> . <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the M $ <br /> Burneft County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and _ SJCy <br /> regulations of the State of Wisconsin. m �y <br /> c m <br /> m O <br /> OWNER 6 C f�(es4 O G rTELEPHONE <br /> �/„ m <br /> ADDRESS / � <br /> m <br /> /� 1 <br /> EMERGENCY/FIRE NUMBER <br /> //_S`� ROAD NARtB(��VV V.� <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR / 11 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITIONS p <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo ° <br /> r <br /> STRUCTURE/ADDITION USE: eF jL Y S�/ o <br /> (Home/Cabin;Commercia Business;Bedroom;DM;etc. Z v <br /> o ° <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 11 <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 <br /> dated by the owner. a <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a N <br /> PLOT PLAN o n <br /> m o fi <br /> C Q <br /> a <br /> m <br /> � o <br /> J <br /> 0 I� <br /> O <br /> J <br /> J <br /> O y <br /> rn <br /> Z <br /> Z <br /> O c ZN ' 170. r- O D MU J, m m p <br /> MU <br /> m J J n o <br /> 2.am � a <br /> CONDITIONS OF PERMITo 0 <br /> : <br /> v m < : Z m mJ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F T� a <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. �' i g C <br /> ii <br /> g : o <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl �'nC g : 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 <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. I y 8 <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 i i i i m N p <br /> access to the above described premises at any reasonable time for the purpose of inspection. i i $ <br /> m A H <br /> m ax <br /> M N <br /> SIGN HERE v, a <br /> ( gna re of owner or 401ding contractor) (date) �. <br /> O : <br /> ZONING ADMINISTRATOR $ <br /> TOWNSHIP PE MITS MAY BE REQUIRED $ o N o m <br /> 88888 8 rn <br />