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(',6 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, Will 54872 Office of Zoning Administrator m 'a o o <br /> APPLICATION FOR — LAND USE — PERMITS . f <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 requirements of the m m <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. o <br /> N d <br /> w <br /> OWNER 20.V1�-� QA�G S TELEPHONE J/,S_ � `— ZSZ-Co n £ <br /> o 3 <br /> ADDRESS ��. <br /> EMERGENCY/FIRE NUMBER ROAD NAME �/��/ / /7c�,�G ,///L/✓'(� <br /> LEGAL DESCRIPTION (see tax receipt) ` kk _ 7-T3�/le/t <br /> CONTRACTOR � ✓`�` d'n <br /> TYPE OF PERMIT(S)): DWELLING/BUILDING_ GARAGEIACCESSORY STRUCTURE ADDITION p <br /> o Q <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o � <br /> r <br /> STRUCTURE/ADDITION USE: g Q <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z <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 (DF). o <br /> 3. Show dimensions in feet of thefollowing:(a) building to all lot lines,(b)buildingto 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 <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a N <br /> PLOT PLAN 11 Z <br /> o n <br /> M o` <br /> S C .4-1711vli e-/ /��T /�L� 0 <br /> a <br /> Vill( <br /> 1 <br /> 0 <br /> IN <br /> m <br /> Z <br /> i <br /> ( I v <br /> 0 0 c u m a a : m <br /> 00 M <br /> CONDITIONS OF PERMIT: v < : goo o 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o ? _ Z T`' i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. w I m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Ca O <br /> g S ? n $ f 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 informs. ea m w O <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. 18 m 8 <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 . . in <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have �n1.10 N p <br /> access to the above described premises at any reasonable time for the purpose of inspection. Int g <br /> m 3 <br /> SIGN HERE 8 <br /> (sign re f owner or ilding contractor) (date) x. <br /> ZONING ADMINISTRATOR ��� t <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N N 8 8 O m <br /> ` <br /> N N O O <br /> PIP N m <br /> 888 8888N <br />