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Bu. .tt County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of ZoningAdministrator ni trraat lr 6 � Z <br /> t 0 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 S _ <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Op <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 3 n <br /> regulations of the State of Wisconsin. <br /> CD <br /> OWNER �QOL� TELEPHONE y3"L� a O <br /> f <br /> 1 m <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME LEGAL DESCRIPTION (see tax receipt) ©G C9 c�V I_o'T 5 �3�G 3 1 (� O <br /> Rt�.c `A w V.S; �3�'iZ►�� c cv t5 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> SANITARY—X <br /> _ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION r^ O <br /> 0 <br /> r <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; tommercial Business;Bedroom; Deck;et <br /> z <br /> o o <br /> � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) C <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). o <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b) building to center line of road,(c)building Q Q <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 0 r <br /> dated by the owner. o r' <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSf OFE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 0 3 Nt <br /> PLOT PLAN o a <br /> rn 0 <br /> cI <br /> to s <br /> rn J <br /> O <br /> o <br /> se-f� s ©uler `? b�fi ram- 1- ����5 N <br /> Z <br /> 9In D(/)r> 0 DDO - <br /> m <br /> > <br /> -. <br /> CONDITIONS OF PERMIT: m y. : z C 8 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F. <br /> � T� : -� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. = M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ;f <br /> v`', 6 2 : m <br /> o i B0 9 O <br /> i declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- m 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 informa- ov: <+► rr, <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- _J B <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 authorized person to have . n o <br /> access to the above deAcribed premises at any reasonable time for the purpose of inspection. w <br /> m 3 <br /> W A <br /> SIGN HERE 1 d <br /> (signs re er orb 'dint'c66tractori (date) ' N <br /> o <br /> ZONING ADMINISTRATOR A19ffiI <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> � S � <br />