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04 e <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d mo a <br /> APPLICATION FOR — LAND USE — PERMITS 3. 1 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 9 w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m ,T, <br /> Burnett County Land Use Ordir ance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 0. <br /> regulations of the State of Wisc nsin. y m <br /> w � <br /> n O <br /> re or �e _ <br /> OWNER TELEPHONE <br /> ADDRESS X .Jry w G <br /> EMERGENCY/FIRE NUMBER ROAD NAME V <br /> LEGAL DESCRIPTION (see tax re eipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLIN BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> r- <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> o < <br /> STRUCTURE/ADDITION USE: rAtsp —OCL( rt) ° o <br /> (Home/Cabin;Commercial Busines edroom;Deck;etc.) z o <br /> O O <br /> N <br /> 3 <br /> DIRECTIONS FOR PLOT PU N DRAWING: (Aerial or top view) <br /> 1. Show the location and si of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> 2. Show the location of the ell (W),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions in feet o the following:(a)building to all lot lines,(b)building to center line of road,(c)building -q W <br /> measurement to the ordin ry high water mark of lake, stream, or river. ) <br /> 4. If separate plans are subn tted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. a <br /> NOTE: BUILDING/STRUCTURE L TIONS MUST BE STAKED FOR ONSI-FE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a rn <br /> c <br /> Z c <br /> PLOT PLAN o a <br /> M <br /> 0 <br /> ChP C S <br /> C <br /> � 00 <br /> �T ' s <br /> lNy <br /> ,w <br /> I <br /> 4o <br /> ON <br /> O <br /> m <br /> 2Uj <br /> y <br /> w <br /> IC-3 <br /> 7r\ Z <br /> v � <br /> M r0 En-0m r DD O 'p <br /> c =.H ° <br /> 01 <br /> 6 mm <br /> eM <br /> CONDITIONS OF PERMIT: WD oi <br /> o? g _ M i <br /> 1. DRIVEWAY MUST MEET RIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING F TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =r=I M <br /> 3. NO GRADING OR SHOR LAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ut ; G)0 `s m <br /> f <br /> I declare that this application including any accompanying schedule)has been examined by me and to the best of my know(- <br /> edge and belief it is true,torr ct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- «r m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 8 a p <br /> mation 1 am providing will b relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I T(,�� � o7 <br /> further accept all liability whit h 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 co inty officials charged with administering county ordinances or other authorized person to have O N v <br /> access to the above describe premises at any reasonable time for the purpose of inspection. m 3 'oo <br /> m m A w <br /> SIGN HERE <br /> ) <br /> ( ignature of owner or building contractor) (date) � 8 a' i <br /> X <br /> ZONING ADMINISTRATOR rryq <br /> / NNOxaN W p150Im <br /> TOWNSHIP PERMITS MAY BE REQUIRED C o v m u ® IX tl m <br /> y <br /> oso 0 <br /> 0 <br />