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0)1 a . y <br /> ( <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS - o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the workdescribed and 2 0 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the M c <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and n �� <br /> regulations of the State of Wisconsin. N m <br /> c <br /> r O <br /> 'J' <br /> OWNER y� TELEPHONE 3 <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER 3 (CV ROAD NAME <br /> OO [ t <br /> LEGAL DESCRIPTION (see tax:re eipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLIN /BUILDING GARAGEIACCESSORY STRUCTURE ADDITION o <br /> n 17 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo 0 <br /> STRUCTURE/ADDITION USE: 7 X (01 09 L n ° o <br /> (Home/Cabin;Comm tial Business; Bedroom; Deck; tc.)Ot- 'exist r) � IdGM <br /> o ° <br /> DIRECTIONS FOR PLOT P N DRAWING: (Aerial or top view) <br /> 1. Show the location and sl a 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 o thefollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)buil <br /> measurement to the ordinary high water mark of lake,stream, or river.4. If separate plans are sub itted by an architect,engineer,builder,contractor,etc.,the plans must be signeddated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a rn <br /> PLOT PLAN e Z <br /> U <br /> ry <br /> O <br /> I � <br /> m g�j <br /> ZOE) <br /> s <br /> N <br /> o <br /> y <br /> M � inM � m <br /> 6 pg� 90-N c31 <br /> CONDITIONS OF PERMIT: o < m': Z T�' ' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e E 5 -Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. d, <br /> 3. NO GRADING OR SHO LAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. P' �0 p <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best ofknowl- <br /> edge and belief it is true,torr et and complete.I acknowledge that I am responsible for the detail and accuracy of al informs- a+ym <br /> tion contained in this applica ion(including any accompanying schedule)and I further declare that I recognize that this infori- al p <br /> Mallon I am providing will relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability whi h 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 co my officials charged with administering county ordinances or other authorized person to have O N <br /> access to the above descri premises at any reasonable time for the purpose of inspection. <br /> 9 <br /> SIGN HERE 'r" <br /> a: <br /> ( i nat re of owner o wilding contractor) (datil <br /> ) �' : "'E <br /> o : '>€ <br /> ZONING ADMINISTRATOR <br /> es' x x <br /> HhH M w, It <br /> TOWNSHIP PERMITS MAY BE REQUIRED oN oN m <br /> xx <br /> w <br /> 0 <br />