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1w 0 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U m c /o <br /> APPLICATION FOR — LAND USE — PERMITS 3_ <br /> o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and mc <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 <br /> regulations of the State of Wisconsin. - d <br /> m m <br /> N � <br /> C <br /> m (] <br /> OWNER &O-fr 1..If�y�� TELEPHONE o <br /> ADDRESS 2q S 1O L3 m (� <br /> EMERGENCY/FIRE NUMBER ROAD NAME \J ' <br /> LEGAL DESCRIPTION (see tax receipt) <br /> 1 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> 0 <br /> ° <br /> u r <br /> STRUCTURE/ADDITION USE: o ° <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z <br /> o ° <br /> a <br /> m <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 infeet of the following:(a)buildingto 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. O o <br /> NOTE'. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. an 3 ur <br /> PLOT PLAN o a <br /> M o <br /> C I o <br /> AA1'-IC �\CD m <br /> �1 <br /> I <br /> I m <br /> 0 <br /> N <br /> O <br /> J <br /> m <br /> 0 y <br /> N <br /> Z <br /> 1 <br /> I<_ <br /> N O_ c M Oi 5 o a* m <br /> m �� 2ag: <br /> D 6 m m <br /> CONDITIONS OF PERMIT: c < ,z c g 02 ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f 0 �`R i : 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =r» <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o O i O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o: C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of allinforms- —` . «�y.� m <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. 1 g� $ <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 i O N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. r 3 'oo <br /> m v A m <br /> M m 8 <br /> SIGN HERE <br /> (signatur of owner er building contractor) a <br /> x: <br /> ZONING ADMINISTRATOR <br /> 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED JUN 1 7 ,',3 i o 0 N N m <br /> '/J 000 000 U) <br />