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0/) / <br /> Burnett 0Wnty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator to m <br /> ` APPLICATION FOR — LAND USE — PERMITS <br /> m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <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 _ <br /> regulations of the State of Wisconsin. m <br /> n O <br /> OWNER TELEPHONE F <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME K�r>�ar ly I 0 <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR cc <br /> TYPE OF PERMIT(S): DWELLING/BUILDING�ARAGE/ACCESSORY STRUCTURE ADDITION p <br /> 0 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION0 <br /> o < <br /> STRUCTURE/ADDITION USE: �� ( h [ �t I I�tGV\r'[I Z° o <br /> (Home/Cabin;Commercial Business,Bedroom;Dec ;etc.) Z o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) o <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 (111 ,septic tank(ST),and drainfield (DF). o <br /> 3. Show dimensions Infest 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. 0 S <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 2 <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE ST+ED FOR ONSITE VERIFI TION BEFORE A PERMIT CAN BE ISSUED. 11 -o y <br /> 11 z c <br /> PLOT PLAN o a <br /> w <br /> C <br /> } ! S <br /> 10 <br /> a <br /> �3 L 3 to 0 <br /> ,paw sw mom' <br /> �� .� 6e rerw�� — - � Sfaka out'✓ef���'.,. <br /> l� Fy11 Cabe �r tb <br /> Z <br /> Oyu Sid res tf-�' LIN <br /> �-4t5+t Stn�wt AJF- a� <br /> `TJOni /1, �1 <br /> "Ifo�I I-}tdMtuv ,(„ -{yew <br /> yGt A-IlovQJ !1' <br /> D60(Co yV Dap 17 <br /> c �. <br /> J3 gCo <br /> CONDITIO OF PERMIT: m' g <br /> t. DRIVEN T MEET DRIV Y WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F � �Q <br /> 2. REMOVAL OR C ING OF TREE ND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING ORS ELAND ALTE ONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. °1 M <br /> 10 <br /> C <br /> 1 declare that this application(in ing any accomp ing schedule)has been examined by me and to the best of my knowl- o : : E : <br /> edge and belief it is true,correct an mplete.I acknowledge that I am responsible for the detail and accuracy of all informs- e,a« ': M <br /> tion contained in this application(inclu any accompanying schedule)and I further declare that I recognize that this infor- B p <br /> mation I am providing will be relied upon by he County of Burnett Wisconsin in determining whether to issue a permit. 1 $9 $ <br /> further accept all liability which maybe 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 qdministering county ordinances or other authorized person to have ? o: <br /> ; o <br /> access to the abo)WTIVITcribed pr lees at any reason a time for the purpose of inspection. T B <br /> ,I M <br /> SIGN HERE L 6' <br /> "-(Sigha re f owner Iding contractor) (date) <br /> off <br /> ZONING ADMINISTRATOR $ <br /> ) <br /> TOWNSHIP PERMITS MAY BE REQUIRED --.- - o N 4X <br /> 88888 8 " <br />