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nic `'Pi <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d o4 ' o <br /> APPLICATION FOR - LAND USE - PERMITS 3. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 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. N ° �y <br /> A <br /> OWNER �4,,e \' o-stS.f�-� TELEPHONE 0 <br /> �l.f/ llOO((JJ TT m_ J <br /> ADDRESS F'C D 1 � ( <br /> `f <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR I tom" <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o F <br /> r <br /> 0 N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> DIRECT IONS FOR USE: 0143 Ae <br /> v <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) oZ o <br /> 0 <br /> m <br /> n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> IQ <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). <br /> r <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (OF). ° <br /> 3. Show dimensions in feet ofthefollowing:(a) building to all lot lines,(b)buildingto center lineof road,(c)building <br /> measurement to the ordinary high water mark of lake, stream, or river. 0 <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 STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. `1I o m <br /> PLOT PLAN Z Q vl <br /> o n <br /> rr m � <br /> -dee �� - <br /> I <br /> N <br /> N <br /> n <br /> O <br /> IF7 <br /> N <br /> O <br /> J <br /> p <br /> c IW <br /> Z <br /> IV M <br /> f <br /> m p c�5irn a� � <br /> O � @ O, m m <br /> Om 9�� O-�.'a y e 31 <br /> CONDITIONS OF PERMIT: <,m'i 'z WC 0 <br /> 8 0 ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F -'z <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. N o mO <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my for o : m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- e+y m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this init. I : i, p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I ori <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- e, <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have l O,� p <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 0 <br /> a <br /> N ' <br /> m <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) `^ <br /> ZONING ADMINISTRATOR +-rte / V 1`/ <br /> TOWNSHIP PERMITS MAY BE REGOIRED o N � m <br /> 000o m <br /> 000 o $ a rA <br /> e» <br /> 1 � <br />