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« <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ) iof 'Z <br /> APPLICATION FOR - LAND USE - PERMITS m 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and H ° <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the require <br /> mems 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 /> N d <br /> w � <br /> I n c <br /> OWNER b`V� �� �_ ,f(�ZA� / ) TELEPHONE n _ , 0 <br /> ADDRESS �yilll C <br /> b4aS Pc, �L � t �a� (r� rY��J 5537 m d <br /> T <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> n <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> 0 ) <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> r <br /> STRUCTURE/ADDITION USE: o ° <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) m <br /> Z o <br /> 0 0 <br /> m <br /> a <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 /> 2. Show the location of the well (W),septic tank (ST), and dreinfield (DF). <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building I <br /> measurement to the ordinary high water mark of lake,stream, or river. C <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. 11 a m <br /> c <br /> PLOT PLAN n o n <br /> C 1 ° <br /> Ached C S r11 m <br /> � y <br /> V. <br /> \nn/ <br /> ^\ N <br /> v1 <br /> 0 O <br /> Q y <br /> N <br /> Z <br /> 1rVyIIIIr1/1 A <br /> 1 I <br /> G <br /> M ro a� � <br /> m pg� nmy° 5 <br /> CONDITIONS OF PERMIT: v C 0 M <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c o : �Z 1 <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. m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- E o 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 m a m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue apermit. I- +-+�.- : $� 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- ' <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to haveO N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. N o 0 <br /> m v A m i <br /> m m <br /> SIGN HERE y $ <br /> o : <br /> : E <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR ':Jij�nn ` $ <br /> �. . <br /> TOWNSHIP PERMITS MAY BE REQUIRED O NT N UO N N p N m <br /> $ $ $ $ $ $ $ $ y <br />