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nl &V PI <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator S m E o <br /> APPLICATION FOR — LAND USE — PERMITS ' <br /> o �O <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permitfor the work described0 and m c <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 I&A s and <br /> regulations or the State or Wisconsin. <br /> e <br /> CWK f <br /> OW _aVj L, 6TELEPHONE <br /> a"- a 0 <br /> ADDRESS ( . pme <br /> f✓S�i��e '� � e r� <br /> EMERGENCY/FIRE NUMBER o0 3 ROAD NAME NG PrXEi' j <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR S5,F. <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> 0 <br /> w r <br /> o � <br /> STRUCTUREIADDITION USE: <br /> (Home/Cabin;Commercial B 'ness;Bedroom;Deck;etc.) o p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) v <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). I r <br /> 2. Show the location of the well (W),septic tank (ST),and drainfieid (DF). I ° <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. Q <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sig ed and 'A <br /> dated by the owner. Q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE UED. 7I 3 rn <br /> 1! Z v <br /> PLOT PLAN A p < I <br /> � /� � �l p M <br /> J` I��C%1 )eat 111 '� <br /> I I <br /> o G <br /> r <br /> O o` <br /> N <br /> I <br /> 2 <br /> V ` <br /> m <br /> a <br /> g �Z:_ � c"I A C <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o <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. re n p <br /> E C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- MON: 9 <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of II informs- of G <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize the this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I i i 8`. 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providin in this ap- , <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized pan on to have ' m O <br /> access to the a described premises at any reasonable time for the purpose of inspection. o <br /> SIGN HERE - N <br /> (sl at roof owner or I Ing cot t r) <br /> 8 : <br /> ZONING ADMINISTRA <br /> M. N <br /> TOWNSHIP P RMITS MA BE REQUIRED - 8 N N.8 m <br /> 888888$8rrn <br />