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N 604, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS d 3 — <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <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. o <br /> m m <br /> m � <br /> n O <br /> OWNER In /�� o TELEPHONE E <br /> / o ' <br /> ADDRESS a, S ( -. k m <br /> J I <br /> EMERGENCY/FIRE NUMBER - ROAD NAME <br /> S <br /> LEGAL DESCRIPTION (seetax receipt) <br /> CONTRACTOR I—I I I / / F v 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ARAGE/ACCESSORY STRUCTURE ADDITION p <br /> O <br /> SANITARY _ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o <br /> W n ' <br /> � <br /> r <br /> STRUCTURE/ADDITION USE' o o <br /> (Ho a/Cabin; Commercial Business; Bedroom;Deck;etc-) Z <br /> 0 0 <br /> D <br /> m <br /> 3 <br /> DIRECTIONS FOR PLOT PLAN DR WING: (Aerial or top view) <br /> 1. Show the location and size of a I existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> 2. Show the location of the well ,septic tank (ST), and drainf)eld (DF). <br /> 3. Show dimensions in feet of the f Ilowing:(a) building to all lot lines,(b)build{ngto center line of road,(c)building <br /> measurement to the ordinary hic It 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 9 <br /> dated by the owner. O o <br /> NOTE, BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a m <br /> PLOT PLAN 0 rr <br /> o n <br /> m <br /> C ' <br /> 1I �� <br /> oc) <br /> I Is� <br /> , I <br /> G <br /> c <br /> 0 <br /> O <br /> b <br /> O � <br /> � I <br /> 2 <br /> jo <br /> I <br /> C <br /> G <br /> 0 p. c<�0 r 0 am <br /> * rh <br /> 00 $�G '- d m O; <br /> a m firCm V.F <br /> CONDITIONS OF PERMIT: 0 : Z $ T+ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o £ M �� <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. <br /> RE : O <br /> I declare that this application(includ ng any accompanying schedule)has been examined by me and to the best of my knowl- o: m C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- a y a m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this inlor- CJ a g p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 E e� o [ <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- y <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have O N p <br /> access to the above described premises at any reasonable time for the purpose of inspection. w m <br /> N : m A m <br /> N <br /> M m O <br /> SIGN HERE <br /> (signatu e f owner or building contractor) (date) <br /> VE <br /> ZONING ADMINISTRATOR ° 8 <br /> d•a«afn raa 'n <br /> OWNSHIP PERMITS MAY BE REQUIRED o N u" ^n d 0 m <br /> 00000800u) <br />