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nna- (- <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and c o <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the CID <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 /> N N <br /> OWNER TELEPHONE FO <br /> 10 f �/ / Ind fes— a <br /> ADDRESS •C,/�SJ�l,1 �-Ul.° �/ YVP�ST_ I�: -5W� <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 /> n O 1\ <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o < <br /> r <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) _ O <br /> 0 0 <br /> v <br /> ro <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 In feet of the following:(a) building to all.lot lines,(b)building to center line of road,(c)building q <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 signed and <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I -o ur <br /> c <br /> PLOT PLAN A _ a <br /> m m <br /> I o <br /> C <br /> 11 (0 . 1 7 N <br /> o <br /> J, <br /> N <br /> C <br /> z <br /> DDO y <br /> 0n 0 <br /> c o.> 0i a� m <br /> CONDITIONS OF PERMIT: <br /> m 0 C8 <br /> 7 <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. F =m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N: O2 : m <br /> ig 0 ` i C <br /> 1 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 I am responsible for the detail and accuracy of all informa- i "i <br /> al o p <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 0`$ 0 <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 ON p <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 o m <br /> a <br /> mg : <br /> M y p <br /> SIGN HERE <br /> H: <br /> (signature of owner or building contractor) (date) E 0 : - <br /> ZONING ADMINISTRATOR \,,m '7 1(11r�C1 <br /> �Fnwtn Z' •n fnwT <br /> TOWNSHIP PERMITS MAY BE REQUIRED o N N m <br /> M <br /> 000000000 <br />