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Burnett Cou" 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o c <br /> APPLICATION FOR - LAND USE - PERMITS ' <br /> m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the a C <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. �, m <br /> w m <br /> / c <br /> F <br /> A <br /> OWNER TELEPHONE <br /> /7p4 .. v <br /> ADDRESS h,„x �j/ 2• J/ -el I/I// f. <br /> EMERGENCY,/FIRE NUMBER 5`Z _31' G ROADNAME ✓ ~� L1 �J <br /> LEGAL DESCRIPTION (see tax receipt) <br /> J/ Q aer S• /0 0 <br /> CONTRACTOR �7 . <br /> TYPE OF PERMrr(S): DWELLING/BUILDING GA GE/ACCESSORY STRUCTURE ADDITION o V <br /> 0 GI <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o o <br /> 0 <br /> r <br /> STRUCTURE/ADDITION USE: <br /> o ° <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> o J� <br /> 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). <br /> 2. Show the location of the well (W),septic tank(ST),and dralnfleld (DF). <br /> 3. Show dimensions Infest 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 9 <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I 3 <br /> PLOT PLAN CAW— <br /> Z v <br /> o <br /> C <br /> i <br /> M <br /> i <br /> � <br /> N <br /> 1 � <br /> a <br /> o <br /> I� <br /> N <br /> I� <br /> Z <br /> l � <br /> mD o c 0 D a rs F m m <br /> DL x <br /> CONDITIONS OF PERMIT: < m-i o:,`i a0o 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 0 N : <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. £ ' c r9r1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. rn <br /> � . p <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- ig C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all inforrna- m <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize that this infor• 0 <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I a <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 pe it county officials charged with administering county ordinances or other authorized person to have n� <br /> access to the above scribed remises at an ason le time for the purpose of inspection. T B F <br /> E o Ale X:P'40 <br /> a E <br /> SIGN HERE <br /> (signature 6rowner or i np Ow € $ <br /> € € 8 ? P: <br /> ZONING ADMINISTRATOR ' E E <br /> TOWNSN PERMITS MAY BE REQUIRED is 9 H 9 o'o� m <br /> r388888888ai <br />