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W„ <br /> Burnett Cgynty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d ' o c <br /> APPLICATION FOR - LAND USE - PERMITS <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes j <br /> 9 by application for a Permit for the work desc ibed and m jW <br /> c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme its of the <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. w m <br /> g <br /> e o <br /> OWNER y��� ) / h i TELEPHONE�_ -/ _ _ L� a _/ D <br /> !� /l O m <br /> ADDRESS !�' G <br /> EMERGENCY/FIRE NUMBER j ROAD NAM tgZ <br /> LEGAL DESCRIPTION (see tax receipt) JJ` S, _ / <br /> Y C <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> G1 <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT n <br /> SUBDIVISION 0 <br /> g� o <br /> STRUCTURE/ADDITION USE: I 1 1 it. 'i-)'yLCo — <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z v —� <br /> 0 0 <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 (OF). 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 0 <br /> dated by the owner. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a m <br /> PLOT PLAN Z `v <br /> � o a <br /> 7 <br /> C <br /> IJJ <br /> m W s <br /> /II � <br /> r <br /> m <br /> 0 <br /> i <br /> 0 <br /> m <br /> O y <br /> Z <br /> D <br /> �am �m m m <br /> CONDITIONS OF PERMIT: q m 2,: R c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e ffi <br /> o Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. o o: <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m <br /> I declare that lois application(including any accompanying schedule)has been examined by me and to the best of1 <br /> Iy know!- o l <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of al I informa- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that i his infor- <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 O; p <br /> access to the abov scribed tae enY onable time for the urPdse of Inspection. ' e <br /> T <br /> r <br /> SIGN HERE <br /> (signature of owner%r build(O contractor) (date) h E « <br /> ZONING ADMINISTRATOR $ <br /> TOWNSHIP PERMITS MAY BE REQUIRED °» tn 't <br /> ONUNiaNto NO In <br /> $ $ $ $$ $ $$ N <br />