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Ofl <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3. 3 <br /> d <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m c o <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 3 n <br /> regulations of the State of Wisconsin. <br /> C <br /> C <br /> ®K�7 f 'yr�4 c /J m � w O <br /> OWNER ML21/I�`�7K� sou J 1 lrr TELEPHONE 1 _ 1 10 _ ISO O {� m <br /> ADDRESS .-Jl. 2n cetgTR- yo �RIo2 �K- Mn -����V z tQ .� <br /> EMERGENCY/FIRE NUMBER ROAD NAME I <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR r <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION o ° :-u <br /> STRUCTURE/ADDITION USE: /,C,ti Fe{rpt o °_ <br /> (Home/Cabin;Co mercial Business;Bedroom ck;etc.) T m <br /> 0 o { <br /> o � U <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 .4 `1 <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. in 3 N <br /> c <br /> PLOT PLAN o v <br /> M Q o <br /> C , <br /> s1 �� <br /> M v <br /> I <br /> o <br /> N <br /> O <br /> J � <br /> J <br /> m /1 <br /> v � <br /> N <br /> m c m r 02 t <br /> g� 2 a m Q m <br /> 31 6 w <br /> CONDITIONS OF PERMIT: a S.LA : c $ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F o i �� ' -q <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. <br /> 2)2 m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edgejil <br /> and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> mtion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- �� `� B g p <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g`$ <br /> o : <br /> further accept all liability which may be a result of the County of Burnett relying on this information t am providing in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have 0, 0 : <br /> access to the above described premises at any reasonable time for the purpose of inspection. N o m <br /> o : <br /> /—fes syJ � e <br /> SIGN HERE ' <br /> (siorlitpre of owner or building contractor) (date) <br /> _ o <br /> ZONING ADMINISTRATOR I _ (' I a r--r <br /> 8i i <br /> TOWNSHIP PERMITS MAY BE REOUIRED�i�1 " " T <br /> IIL , W ZQM <br /> boo 6000 <br />