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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d 'ao 0 <br /> APPLICATION FOR — LAND USE — PERMITS . <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w 0 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the AC 1 <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. H <br /> N <br /> OWNER / / I�,(�, TELEPHONE /_a - Zj n O <br /> ADDRESS 'j A io l PM`I/Q,C �/'G(JY �IAC M n S—iS— 7 / I , ` � <br /> EMERGENCY/FIRE NUMBER ROAD NAME ea"- <br /> LEGAL DESCRIPTION (see tax receipt) I� J <br /> See OA C� <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> o <br /> '^ r <br /> STRUCTURE/ADDITION USE: Cabin o ° <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) :? <br /> Z <br /> 0 o0 /t� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) Q � <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 <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 <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSfrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I o 0c <br /> PLOT PLAN Cttnv 45 `vW o o a <br /> X90, C <br /> I fA <br /> m <br /> o` <br /> 1 <br /> 1f o <br /> CA <br /> N o <br /> 4r>Orcllna <br /> hi511) WeA4,err z <br /> I �s <br /> ryt0-'r <br /> �Yvl <br /> River <br /> M1� D maN <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRI E AY WIDTH REQUIREMENTS WIT IN 60 DAYS OF PERMIT ISSUANCE. o F ? T� <br /> 2. REMOVAL OR CUTTING OF TRE ND VEGETATION IS REST ICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTEFTATkONS ARE ALLOWED NLESS SPECIFICALLY PERMITTED. : F n <br /> g m m <br /> I declare that this application(including any accomp %ng schedule)has been examined by me and to the best of my knowl- o O <br /> edge and belief it is true,correct and complete.I acknow d e th t I am responsible for the detail and accuracy of all informs- w m <br /> tion contained in this application(including any accompanyin chedule)and I further declare that I recognize that this infor- I 8 3 . <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 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- in <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have 00 <br /> access to the above described premises at any reasonable time for the purpose of inspection. 01 8 <br /> m V A <br /> SIGN MERE a v,_If i N <br /> (si re of owe or building contractor) --� <br /> i <br /> 0 <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED �1\ o o <br /> U 88 <br /> [LIC s>ZF6- c <br /> 8 <br />