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A aryl <br /> BumeH County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator N a o 0 <br /> APPLICATION FOR — LAND USE — PERMITS Is <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work tlescribed and v <br /> located as shown herein. The undersigned agrees that all work shell be done in accordance with the requirements of the $ <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the latus and <br /> regulations of the State of Wisconsin. v <br /> OWNER M6 TELEPHONE <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ��{ ROAD NAME <br /> _nr t r <br /> LEGAL DESCRIPTION (see tax receipt) Q/ <br /> — 1 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ADDITION o -� <br /> Ct d <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` ° �� <br /> STRUCTURE/ADDITION USE: S7U YTl� AN <br /> � <br /> (Home/Cabin;Commercial Busi ss;Bedroom;Deck;etc.) o p <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 (Vi),septic tank (ST),and drainfield (DF). i <br /> 3. Show dimensions In feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)(building r <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. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '1I o rn <br /> 11 z co <br /> PLOT PLAN ° <br /> M 0 II¢N1! <br /> 111 1/� <br /> I <br /> 0 <br /> 0 <br /> m <br /> v � <br /> Z <br /> S � rDDOy <br /> g m <br /> CONDITIONS OF PERMIT: I -i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> C <br /> Z 4 Z :: N <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _G12 D <br /> ` ` 33` rn <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �In E <br /> 4g �Ei <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 1 am responsible for the detail and accuracy of tall informs- rn <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize thalt this infor- i O <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issu a permit. I <br /> $� $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providin in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized psi to have iP <br /> access to the above described premises at any reasonable time for the purpose of inspection. n ; p 3 <br /> N in <br /> SIGN HERE <br /> (signature of ovaes/ ct <br /> or puilylhp reaor) (date) . <br /> \YYYI'Io I1YpY,( ct <br /> ZONING ADwurcrwarnn <br /> VV, <br /> NN NMHN+ T <br /> TOWNSHIP PERMITS MAY BE REQUIRED In <br /> $8888 vmi <br />