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Cyte. <br /> S f <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 548Office of Zoning Administrator oz72 _ � <br /> APPLICATION FOR — LAND USE — PERMITS m o <br /> e <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 5k $ C, <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and _ o <br /> regulations of the State of Wisconsin. m <br /> j M' ^h £O <br /> OWNER i'�`^J �Y' �l !J J�(i(--1 J TELEPHONE <br /> ADDRESS �a'-/��� V2(- <br /> EMERGENCY/FIRE NUMBER ROAD NAME ) <br /> LEGAL DESCRIPTION (seetaxreceipt) r <br /> CONTRACTOR C, <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O <br /> 0 J <br /> SANITARY PRIW FILLING/GRADING CAMPING UNIT SUBDIVISION 6 �. <br /> m <br /> STRUCTURE/ADDITION USE: '9 J <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z o <br /> 0 0 <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). I Q <br /> 2. Show the location of the well (W),septic tank (ST),and drainflaid (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 o <br /> measurement to the ordinary high 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 O <br /> dated by the owner. C 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrrE VERIFICATION BEFORE A PERMrr CAN BE ISSUED. Z c <br /> P n <br /> PLOT PLAN -,9 j y <br /> I 0 <br /> L� i IL `�- <br /> o : <br /> Qm <br /> �> <br /> O I� <br /> m <br /> �l7 z <br /> f � <br /> r>D f� a0 mi <br /> o D B <br /> cm <br /> CONDITIONS OF PERMIT: oZ f 5 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 00 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. rn; <br /> 9� N : At <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. E : . C <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 O a m <br /> fff" ,a g <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. <br /> matlon 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a pe . I E E o� o <br /> rmit <br /> further accept all liability which may be a result of the County of Burnett relying on this information I arrl providing In this ap- i <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have ; 0.0 o: <br /> access to the above described premises at any reasonable time for the purpose of inspection. m i v a w <br /> m <br /> SIGN HERE (date) <br /> (signature of owner or building contractor) x <br /> 8 <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED o ^ " a " m <br /> 88888888th <br />