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4" y' <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54072 Office of Zoning Administrator m 9)-0 0 <br /> APPLICATION FOR - LAND USE - PERMITS . f <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the r0quireme nts of the m c <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. <br /> Cc m <br /> m O <br /> OWNER 7 A D, 3 v e, h TELEPHONE/G �� _ a G_�/ <br /> 7 m <br /> r <br /> ADDRESS o2 G �� d Lt/ ,'Ia <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVYFILLING/GRADING CA PING UNIT SUBDIVISION o o <br /> STRUCTUREIADDITION USE: O <br /> g <br /> (Home/Cabin; ommercial Business;Bedroom; Deck;etc.) Z �I <br /> 0 0 <br /> 9 <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 No h (N). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DIF). o <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c I building .4 <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 at 3ned and a 0 <br /> dated by the owner. Q c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE SSUED. '111 c N <br /> PLOT PLANZ C <br /> ` / // 7�-7 /��r1/ � o n <br /> III <br /> 1 C rw <br /> o <br /> S mower m9 <br /> �I <br /> 0 1/J <br /> C� <br /> Idr ' } <br /> V r Q <br /> v/ <br /> I" <br /> a : m <br /> n �4e <br /> e <br /> CONDITIONS OF PERMIT: o m y,: Z cg <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 0 io'S': 1'2 -1 <br /> O O __N; <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. rn <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of y knowl- : 4 <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of a I informa- T <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- 8 '. p <br /> matlon 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g� $ <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 O'. Cl: <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> m <br /> SIGN HERE <br /> i HE E <br /> (signature of ow r iljcjfracton (date) <br /> ZONING ADMINISTRATOR ; $ <br /> -nTOWNSHIP PERMITS MAY BE REQUIRED �m r�t�� N <br /> O N N O N N N O m <br /> g $ g $g$ $$ W <br />