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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m 'ao 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> 1 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the require ms of the <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and t e laws and <br /> regulations of the State of Wisconsin. <br /> j�OWNER t TELEPHONE (a • -c �(%� I k <br /> B "I nwc It O m <br /> 77, <br /> EMERGENCY/FIRE NUMBER ROAD NAM <br /> ne, > <br /> LEGAL DESCRIPTION (see tax receipt) , / <` - V� I <br /> CONTRACTOR <br /> �P.l L°r"diUSD/� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o177 <br /> l/ <br /> t _ <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin;Commkircial Business; Bedroom; Deck;etc.) Z <br /> 0 0 <br /> � IL <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,1 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 besigned and <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on a N <br /> c <br /> PLOT PLAN o 'a _ <br /> III <br /> C 1 <br /> 0 <br /> z <br /> O o <br /> N 111I <br /> _ <br /> O y <br /> �R <br /> J = <br /> MM <br /> CONDITIONS OF PERMIT: o. & <br /> o g: z ffi g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c E IQ 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. —o, 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m <br /> V4 � ; ID <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o i L C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy o all informs- 0 f •"m N i T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- .{ v $ l p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issu i a permit. 1 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I ern Drovidi g In this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized ps on to have m: - <br /> access to the above de ribed premises at any reasonable time for the purpose of inspection. - <br /> SIGN HERE N <br /> N: <br /> (signature o owner or building contractor) (date) 2X� <br /> ZONING ADMINISTRATOR <br /> cNN�NNNy 1l <br /> TOWNSHIP PERMITS MAY BE REQUIRED No Sr (X g N g m <br /> -'88888888 vi <br />