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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54472 Office of Zoning Administrator S o' E o <br /> APPLICATION FOR — LAND USE — PERMITS ' <br /> TO TNI=20NING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be clone in accordance with the requirements Of the 0 C -C <br /> Burnett County Lard Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and - `S <br /> 0 <br /> regulations of the State of Wisconsin. ,w, m <br /> CL <br /> o <br /> OWNER G) c�I \ c p�_ 1- 1 TELEPHONE �,1a>l,(�')��j� -3.(,"3 m_ 1D <br /> ADDRESS �}R PelS"\� l� �� ��� A1C /I a <br /> EMERGENCY/FIRE NUMBER C/�_,� j j ROAD NAME _ Q � <br /> i <br /> LEGAL DESCRIPTION (see tax receipt) i{ )�i /01A) \ <br /> trt , v <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> O <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION o` ° <br /> o ' <br /> '^ r <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z o <br /> o c <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). r <br /> 2. Show the location of the well ,septic tank (ST),and drainfield (DIF). 4 <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. Q <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. o <br /> NOTE :BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSFE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '111io u+ <br /> 11 Z c <br /> PLOT PLAN ° M <br /> • c�e C <br /> C <br /> nai si <br /> N <br /> 0 <br /> 0 <br /> Ivv <br /> m <br /> v <br /> o <br /> a <br /> I09 <br /> Z <br /> ago MO <br /> 0. �$� baa <br /> CONDITIONS OF PERMIT: Z e :i `z g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 0 4 E E <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. rgn• 33 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �' O m <br /> X <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 « ; m <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize that this infor• $ p <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I Oa $ $ <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.1 agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described promises at any reasonable time for the purpose of Inspection. T <br /> $ a . <br /> SIGN HERE <br /> (signatu ow r IIdIn4 contractor) (date) ; t <br /> 11 <br /> ZONING ADMINISTRATOR �_ <br /> TOWNSHIP PERMITS MAY BE REQUIREDt9i"'8 m <br /> 8888818 vmi <br />