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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the lJ <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and �_ a <br /> regulations of the State of Wisconsin. <br /> w o m <br /> w V <br /> p /1 <br /> OWNER Y T pQ, a TELEPHONE 9 <br /> F <br /> ADDRESS !t <br /> ,f NLLLA re. <br /> EMERGENCY/FIRE NUMBER <br /> ROAD NAME 1p <br /> f <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR t <br /> P <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDTION <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> o _t <br /> l r <br /> STRUCTURE/ADDITION USE: �0 0 -rp-- n d 7-1 n/9 / o Y C <br /> (Home/Cabin;Commercial Business; Bedroom;Deck,etc.) Z <br /> 0 0 <br /> a <br /> m <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 drainfield (DIF). <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)buildingto center line of road,(c)building 1A <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 <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. a v N <br /> PLOT PLAN Z <br /> P a <br /> 0 <br /> C <br /> r <br /> 0 <br /> J <br /> N <br /> O <br /> JDO <br /> J <br /> 2 <br /> w <br /> Z <br /> I x <br /> D NN ] N r D U <br /> 0 c . > j a m <br /> Er <br /> a33 <br /> CONDITIONS OF PERMIT <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ a <br /> = m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O <br /> 8 . <br /> n C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <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. I $ m $ <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- w <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> 000 <br /> access to the above described premises at an reasonable time for the purpose of inspection. cTi 3 $ $ <br /> m m a m <br /> SIGN HERE m $ <br /> (signature oner orb d'ng contractor) (date o s ' <br /> ZONING ADMINISTRATOR + 8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N .0 N N M " T <br /> N NfII O N00 .rb' m <br /> $ $ $ $ g g g $ y <br />