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%A1I'SCc n_5111 6�2 �'� <br /> ,nett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 3 o <br /> AAPPLICATION FOR — LAND USE — PERMITS d o <br /> TO THE'ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w � <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordina ce,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> o <br /> regulations of the State of Wisconsin. <br /> m O <br /> n <br /> OWNER jZ C TELEPHONE <br /> IC 3 m <br /> ADDRESS JL6Lj / V. _ SC <br /> EMERGENCY/FIRE NUMBER {-� ROAD NAME �' d <br /> LEGAL DESCRIPTION (see tax ret pt) <br /> ) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S). DWELLING/ UILDING GARAGE/ACCESSORY STRUCTURE ADDITION O <br /> Y � O <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION �. <br /> � m r <br /> o a <br /> STRUCTURE/ADDITION USE: v <br /> (Home/Cabin;ComrngAial Busine s; Bedroom;Deck;etc.) Z <br /> o a° <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 thew II (W),septic tank (ST),and drainfield (DF). <br /> 3. Show dimensions In feet of he following:(a)building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordiruity high water mark of lake,stream,or river. <br /> 4. If separate plans are submi ted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. C o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I o cn <br /> 71 z `v a <br /> PLOT PLAN <br /> 111 rrA �— <br /> IrU1 - <br /> C) <br /> — m <br /> o <br /> � dI <br /> ~ J_ d <br /> z <br /> l <br /> f <br /> 0. D g,� 2.a N =- 37 <br /> ?: � <br /> o <br /> CONDITIONS OF PERMIT: gz <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a- <br /> 2 REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. v. <br /> 3. NO GRADING OR SHO LAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 0 : a 2 C) <br /> $ i C <br /> I declare that this application including any accompanying schedule)has been examined by me and to the best of my knowl o - M <br /> edge and belief it is true,torr ct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa m <br /> �and G <br /> tion contained in this applica on(including any accompanying schedule)and I further declare that I recognize that this in of. <br /> mation I am providing will b relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 $� <br /> further accept all liability whi h may be a result of the County of Burnett relying on this information I am providing in this ap- Q N o <br /> plication.I agree to permit c my officials charged with administering county ordinances or other authorized person to have <br /> access to the above descriN J premises at any reasonable time for the purpose of inspection. .n 3 $ t <br /> SIGN HERE "1 etWee^ <br /> _n <br /> ZONING ADMINISTRATOR , i g ' K i <br /> y1 d1N�HX <br /> (qy <br /> I m <br /> i I tX of <br /> TOWNSHIP PERMITS MAY BE REQUIRED ONin �y m <br /> v� o00 0 <br /> 00030 i (n <br /> an <br /> 0 <br />