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on <br /> Bumett County 7410 Co. Rd. K. No. 102, Siren, WI 54872 Office of Zoning Administrator w m o OZ <br /> APPLICATION FOR — LAND USE — PERMITS d 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q w o <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. 'p <br /> w m <br /> w � <br /> OWNER TELEPHONE �fJ ry c O <br /> r � 3/fes Q=6_ �{ L� j <br /> ADDRESS BELK n/AP !7—/ LT ;d IS UJ�'Riiog . kll <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) C <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION O <br /> o <br /> o < <br /> � s <br /> STRUCTURE/ADDITION USE: o 0 (O <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) v <br /> 0 o <br /> O O <br /> I� N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) I- <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). 0 K <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF), o <br /> 3. Show dimensions in feet ofthefollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)building -q <br /> measurement to the ordinary high water mark of lake,stream,or river. pp <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 BE ISSUED 3 <br /> n <br /> PLOT PLAN A o a <br /> M w <br /> d 0 <br /> �AcN � o!, <br /> lart <br /> 0 <br /> � y <br /> w <br /> i1 Z <br /> G <br /> m rg) (n'9 V r D DOM <br /> —a4 <br /> m '- pmamm <br /> CONDITIONS OF PERMIT: v m y: Z c 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m o: g.z : —I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N t7 m <br /> 2 ; O <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- H m H m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- $ B g p <br /> Mallon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 o o <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 N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m o m <br /> no w0 <br /> SIGN HERE <br /> (signaturef owner or bujidin ji6mrac <br /> o : <br /> ZONING ADMINISTRATOR I o <br /> TOWN P PERMITS MAY BE REQUIRE 1�-Oo Coo <br /> N N N�N m <br />