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Bumett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator (n M o 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3. <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and '2w ° <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 <br /> regulations of the State of Wisconsin. m <br /> N <br /> C <br /> 0 <br /> OWNER 'BOJJBRAM\. E 1 TELEPHONE �I Z-' "710 _L /3D7 /] n £ <br /> ADDRESS �/ Z/ q �R PgNTEU R AW. P1 APLEW OOD, M d • SS 0-1 <br /> EMERGENCY/FIRE INOUMBER ROAD NAME Q) <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF RFAIT( ): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n 0 <br /> SANIT PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> STRUCT DITION USE: � 1 o ° <br /> (Home/Cabin;CommercialB siness;Bed ro m;Deck;etc.) Z <br /> o ° <br /> a <br /> m <br /> 3 <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). 0r <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). o <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to 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. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a N <br /> c <br /> PLOT PLAN n <br /> MTLY0 <br /> 0 <br /> C 1 <br /> m <br /> A-Mfi c o <br /> o e wf'1T le al 'e�I p�n �hs��e f <br /> e�Ct�re <br /> a �,,41rl Jona 177 �� 7 r/ ��� <br /> �440 r 0 <br /> 0 <br /> AdN <br /> 1 <br /> � I <br /> D o c m m n a F m <br /> CONDITIONS OF PERMIT: m = m C0 (0 <br /> a o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F ? 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.' I g C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- lJ' o m <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informa- v+ m er 0 <br /> m N <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- I . ro N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 8 m 8 <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 have N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> //� ° A N <br /> L .. <br /> SIGN HERE a <br /> (signature of owner or building contrac <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS IYAY BE REQUIRED S� <br /> 8 8 " <br /> u rn <br /> $ m <br /> 9 gggg to <br />