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l <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratorm M 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and u <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c <br /> Burnett County Land Use Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. w m <br /> w ,^p <br /> n O <br /> OWNER 31104- TELEPHONE m <br /> ADDRESS 42 i4r 1n AW. W)rXD <br /> m <br /> EMERGENCY/FIRE NUMBER ROAD NAME �^ <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o n 1 <br /> O <br /> O Qj <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 ° <br /> m r <br /> ° ° <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) z o <br /> 0 v <br /> } <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 (yi), septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions infeet of thefollowing:(a)buildingto all lot lines,(b)buildingto center line of road,(c)building <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 <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a N <br /> c <br /> _ Z c <br /> PLOT PLAN ° a <br /> fn <br /> 'kd <br /> I ' <br /> Chea CSM M <br /> V 4 Pb m <br /> n <br /> 0 <br /> N I�JJ <br /> ;Cad2�- � .��� W� �`��� � � <br /> ati <br /> �(�Gf o <br /> a;� ��rt�� r� <br /> � Ny � ulr DDO V <br /> mm <br /> CONDITIONS OF PERMIT: <. m m o D c, 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. oz f s T•z D <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ' m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �" iCDn C <br /> '. g : :,gym <br /> c . <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl S i Tom `� m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- :ow 0 rn O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- :09 i; N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I ,/�-`, <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- 1�'� N <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have .�O ut o <br /> access to the above described premises at any reasonable time for the purpose of inspection. E03 A <br /> M _Ory Ap N <br /> m N O <br /> N : O <br /> m <br /> SIGN HERE n <br /> (signature of owner or building contractor) (date) s <br /> ZONING ADMINISTRATOR <br /> vi,ei � T <br /> TOWNSHIP PERMITS MAY BE REQUIRED � N : 2c <br /> 0 oo S m <br /> 888 �8888G) <br />