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i <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator In I 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> d o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the ai <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. m <br /> w � <br /> c <br /> ` n O <br /> OWNER ���y, 1 o� )a r-, TELEPHONE <br /> TELEPHONE o <br /> r l-V I I LC .� J <br /> I <br /> ADDRESS a7(X�� .29d <br /> EMERGENCY/FIRE NUMBER 111.m p ] ROAD NAME i <br /> LEGAL DESCRIPTION (see tax receipt) } <br /> CONTRACTOR r�1.I C,� _ �-�/ ��•-�.� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o a <br /> J <br /> '^ r <br /> STRUCTURE/ADDITION USE: o Q <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z o <br /> 0 <br /> m <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 (W), septic tank (ST),and drainfield (DF). <br /> 3. Show dimensions infest ofthefollowing:(a)building to all lot lines,(b)buildingto center line of road,(c)building <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 <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 ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I 3 rn <br /> PLOT PLAN 0 <br /> o n <br /> C <br /> I <br /> m <br /> I 1 <br /> o <br /> J(� <br /> N <br /> O }I\\ <br /> J <br /> J <br /> O y <br /> w <br /> 1 <br /> G <br /> D <br /> in (0r- afIT IT <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. E c <br /> P 'Q ; 'H <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P �--y' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o p <br /> 2 ' <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- rn w« m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- <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 a - N <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 g <br /> m A w <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) �' : `B 8 , <br /> o ; <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REOUIRED o N N ou N m <br /> 88888888u) <br />