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ALA <br /> � emp <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, Will 54872 Office of Zoning Admin4trator to m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes m Rot.- <br /> LEGAL <br /> g by application for a Permit for the work descri d and m c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme s of the 2 <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the I ws and <br /> regulations of the State of Wisconsin. w m <br /> J' m OWNER 6(._(c Z (b TELEPHONE 7J� �r %PSQADDRESSEMERGENCY/FIRE NUMBER ROAD NAME <br /> DESCRIPTION (see tax receipt) t35 <br /> I <br /> CONTRACTOR 1 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> oDIK- <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° N <br /> J <br /> H � <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z <br /> 0 0 <br /> 0 <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). <br /> 2. Show the location of the well (W),septic tank (ST),and dralnfieid (D17. <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 sl ned and <br /> dated by the owner. O a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTE VERIFICATION BEFORE A PERMIT CAN BE SUED. on m <br /> C <br /> PLOT PLAN e <br /> A-bite h' <br /> M <br /> W I. <br /> ►U y {� be- <br /> I� <br /> N <br /> m <br /> n <br /> O <br /> ILJ <br /> O Iv <br /> J <br /> O � <br /> N <br /> n I� <br /> ten/' Z <br /> i I <br /> Rm 0 r��nv�nS a* M <br /> i� �a� 4 <br /> 4 _ y <br /> CONDITIONS OF PERMIT CS J�' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORPERMITTED. <br /> ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTEq <br /> N : o <br /> i <br /> 0 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of y knowl- o <br /> edge and belief It is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informa- «+a a In <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 8 g p <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- <br /> plication.I spree to permit county officials charged with administering county ordinances or other authorized person to have : m m <br /> access to the above dpghbed promises at any reasonable time for the purpose of inspection. <br /> m i pi <br /> m e . <br /> SIGN HERE 7 ? ,n iE <br /> (signature wner Ildlnp contractor) ate <br /> o . <br /> ZONING ADMINISTRATOR g E <br /> M. M NMHN+ n <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 4X a r"nN SS m <br /> $ $ $ $ $$ N <br />