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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 0 <br /> '- 3 <br /> APPLICATION FOR — LAND USE — PERMITS d <br /> s 6' <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work describetl and i <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 14 `m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> 0 <br /> regulations of the State of Wisconsin. N m <br /> 7 n O <br /> OWNERTELEPHONES—.lam/ <br /> m <br /> ADDRESS # <br /> EMERGENCY/FIRE NUMBER ROAD NAMES <br /> LEGAL DESCRIPTION (see tax receipt) -3at <br /> ��z L <br /> CONTRACTOR Mu rK ':�,Ae j A-Ve <br /> f <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ,GARAGE/ACCESSORY STRUCTURE2 ADDITION o <br /> �prvr�T 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> Lam_ <br /> STRUCTURE/ADDITION USE: ! 1D✓✓V e LJ ` r�G� ° <br /> (Home/Cabin;Commercial Business; edroom;Deck;etc.) 2 0 <br /> 0 0 <br /> ° <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 /> r <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). <br /> 3. Show dimensions infeet of thefollowing:(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. O <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 <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a 0 <br /> 71 Z a <br /> PLOT PLAN �� <br /> M = r1 <br /> ' I <br /> 1 <br /> V <br /> � o <br /> _ o <br /> i N3 Ji <br /> Z <br /> f <br /> L- r,e i <br /> Tc-osi '> a0 -0 <br /> m m <br /> CONDITIONS OF PERMITL�,fice_ c < Z <br /> 1, DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o T`z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N 77 <br /> H; <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 1 U1 : 62 m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs. m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. r B g <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <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- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 o m <br /> v �l <br /> VV`� i 3/3%3 » g . <br /> SIGN HERE `8 <br /> 7��'7� ( ' tura of ow r or uilding contractor) (date) ? ' ; <br /> Fr: <br /> ZONING ADMINISTRAT/J - <br /> l�/ N N N N N m <br /> TOWNSHIP PERMITS MAY BE REQUIRED co a v Ya u u o <br /> M <br /> C_\0 <br />