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0/-(, C <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o c <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> d <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and -Z w <br /> located as shown herein. The u idersigned agrees that all work shall be done in accordance with the requirements of the 3 a <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. y <br /> w <br /> C <br /> OWNER 6 'O TELEPHONE /12� "Z- -7( m 0 <br /> w m <br /> ADDRESS `l, <br /> EMERGENCY/FIRE NUMBER rr ROAD NAME <br /> LEGAL DESCRIPTION (see tax rec,iipt) - J <br /> i <br /> CONTRACTOR , <br /> TYPE OF PERMIT(S): DWELLING/3UILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> �/ n o <br /> SANITARY ^ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o �' <br /> J � <br /> STRUCTURE/ADDITION USE: o ° =� <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z <br /> O p �i <br /> a <br /> m <br /> DIRECTIONS FOR PLOT PLAIN DRAWING: (Aerial or top view) r <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 thew II (W),septic tank (ST),and drainfield (DF). <br /> 3. Show dimensions in feet ofthe following:(a)building to all lot lines,(b)building to center line of road,(c)building 11 Iiir�J� <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 2 <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1111a to <br /> c <br /> PLOT PLAN n o n <br /> M o <br /> CJ <br /> w ) <br /> M <br /> i <br /> a <br /> Seec�ec� ��,c_�c AArjQS . <br /> Il` <br /> J <br /> J <br /> O y <br /> N 1 <br /> Z <br /> 11 <br /> G <br /> m O c W rn n 0- 0 <br /> m <br /> 3E m <br /> CONDITIONS OF PERMIT: m Z C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z i"o'o i _Q <br /> 2. REMOVAL OR CUTTING O TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �'' 32 � m <br /> n <br /> C is C <br /> 1 declare that this application(i cluding any accompanying schedule)has been examined by me and to the best of my knowl- '� �t. o : <br /> edge and belief it is true,correc and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- Lp. " «w A m <br /> tion contained in this applicatio (including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be r lied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 o`$ S <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 remises at any reasonable time for the purpose of inspection. m 3 $ o <br /> m m A N <br /> _ O : <br /> SIGN HERE rjVL � <br /> 3: <br /> ZONING ADMINISTRATOR <br /> it], <br /> d+«« «««« -n <br /> TOWNSHIP PERMITS MAY BE REOUIRE7 7 o N N N N m <br /> �!, SSS SOOO N <br />