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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator N v z <br /> -APPLICATION FOR — LAND USE — PERMITSm <br /> m 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and H ° <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and a <br /> regulations of the State of Wisconsin. = <br /> m m <br /> OWNER f c <br /> I r I n t ( 1 t TELEPHONE ��6_ &D-SS n �L� O <br /> o \ m <br /> ADDRESS a (f, ^t 1 � l °1 I <br /> _l O- ' O�'1 <br /> EMERGENCY/FIRE NUMBER p ROAD NAME S <br /> LEGAL DESCRIPTION (see tax receipt) 600 �-r�-f �• <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE�— ADDITION <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> 0 <br /> P I ► nn �la ` �0 <br /> STRUCTURE/ADDITION USE: )f I {/ o 0 <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z 'o <br /> o ° <br /> 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). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfleld (DF). <br /> 3. Show dimensions Infeet ofthefollowing:(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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSIiE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. c <br /> PLOT PLAN n c �1 z <br /> acs O �J I n 10 Lti, C� � m o a <br /> / C o <br /> See Ab d),e j , o o, L <br /> � N <br /> 0 <br /> 1 STrur w e h e- t-t T 6 ae "oo <br /> S <br /> z <br /> I <br /> iii a m & m <br /> CONDITIONS OF PERMIT: v m S.: Q c 8 0. 5' r.1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. = m o: <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 9 y <br /> 3, NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N as 2 i In <br /> aa E : O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- g m 4i C <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- �^m" <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that IT <br /> his rma. m <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- $ 0 <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have O N o <br /> access to th ve described premises at any reasonable time for the purpose of Inspection. m m <br /> r 3 $ : <br /> 0 A 0 <br /> SIGN HERE 0 : i <br /> (signs re t owner or b '1 Ing contractor) (date) <br /> Pi <br /> ZONING ADMINISTRATOR <br /> g : <br /> TOWNSHIP PERMITS MAY BE REQUIRED o N N N N n N m <br />