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,2 C-ornp, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator r ' o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> m a <br /> TO THE ZONING 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 done in accordance with the requirements of the m <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. N <br /> c <br /> c <br /> 50 <br /> OWNER / C'./Or / TELEPHONE <br /> / �YY W Ult.nv U 1 r o <br /> m m <br /> ADDRESS /'1 /?jW' !/J/t' <br /> 7/7 WCDJL9 r_ yI J TS <br /> EMERGENCY/FIRE NUMBER ROAD `D <br /> NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR 1 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p �� <br /> n o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> r <br /> STRUCTURE/ADDITION USE: o ° <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z <br /> o ° <br /> a <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). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions infeet of thefollowing:(a) buildingto 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. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 2 <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 9I a rn <br /> PLOT PLAN p n } <br /> m <br /> C <br /> MCMC-0 m <br /> n O <br /> 0 <br /> o <br /> N <br /> Z <br /> < <br /> O.c -N r n Dd 0 -0 <br /> m <br /> CONDITIONS OF PERMIT: $ 5. ,z cg: 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o m'o: Z : .H <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. F H —'N r M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. !n : 6 2 i m <br /> o : @ D <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m 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- `n I"' 71tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- � p <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- <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorised person to have O o <br /> access to the above described premises at any reasonable time for the purpose of inspection. -r1 3 0 0 <br /> ` <br /> m App N <br /> r� j,..� <br /> SIGN HERE '� ~' 2 : <br /> (signet " f o er (d <br /> Ing contractor) I - , ate <br /> of s: E <br /> oi <br /> ZONING ADMINISTRATORiv I <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N m <br /> -- _""--- $ 0 $ $ N <br />