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� VI ( <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Ad-ininistrator m 0 O <br /> APPLICATION FOR - LAND USE - PERMITS <br /> m = <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes — ° <br /> 9 by 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 c V- <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and x. <br /> regulations ofthe State of Wisconsin. o <br /> OWNER/4)A C, ��.,P �L/A�� /41 TELEPHONE G_� L/ 3 4 n e O <br /> -7 <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER 7S S^ ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) C !'le Al j c/ y`j �', /[, AU0 v T 167, <br /> CONTRACTOR C' <br /> TYPE OF PERMIT(S): DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ADDITION p - <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a o L�� <br /> o < <br /> STRUCTURE/ADDITION USE: 1'1�lf6AJ % ITO6 4!'p' /T%O.LJ g _ � <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> Z o <br /> O O <br /> N <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). 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 <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. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN E ISSUED. 3 y <br /> PLOT PLANZ C <br /> A p a <br /> ol �I <br /> fA _. <br /> I <br /> d <br /> I. m <br /> o� <br /> _ <br /> o <br /> w <br /> n <br /> Z <br /> rirc 33 <br /> Pe�m�f� ICYo�I� <br /> C=. 0a ' � <br /> CONDITIONS OF PERMIT: Z 3:; QC g 3 <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m o o'= ffi Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. rn ? _ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. R <br /> qq �iT : C <br /> 5? <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 I am responsible for the detail and accuracy of all informs- .+m e, R <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize t at this infor- B C <br /> mation 1 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 parson to hav O p <br /> access to the above described premises at any reasonable time for the purpose of inspection. w <br /> _ m 3 <br /> m <br /> SIGN HERE <br /> f/ (signature of owner or building contractor) (date) <br /> - w- <br /> Al <br /> ZONING ADMINISTRATOR ` <br /> [ : <br /> TOWNSHIP O&MITS MAY BE REOUIRED <br /> O UNiN ONNNO n <br /> $ $ $ $$ $ $9Ur <br />