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04 v"' T e <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U ' o 0 <br /> APPLICATION FOR — LAND USE — PERMITS �_. £ <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and a o <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 <br /> regulations of the State of Wisconsin. — o <br /> w <br /> OWNERR�+ J�t�4 CIjn(j, TELEPHONE 6::' <br /> ADDRESS <br /> m O£ <br /> ASqV KJ m I = <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR ��. — \ ,I I V PA ,V'`)r <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> n V <br /> SANITARY PRIVY °FILLING/GRADING CAMPING UNIT SUBDIVISION o � <br /> 0 ^ <br /> STRUCTURE/ADDITION USE: r <br /> o o_ I <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z v RI <br /> O 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 (DF). o <br /> 3. Show dimensions In feet of the following:(a)building to all lot Imes,(b)building to 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 9 W <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE SSUED. 0 o rn <br /> PLOT PLAN Z ` <br /> a <br /> A o o. <br /> 5 <br /> o <br /> a � <br /> f8 I <br /> VIP <br /> J6 <br /> ra s <br /> J m <br /> 0 <br /> � o <br /> 2cn"I n l am m-, V-e' i rt0 6E- <br /> Z <br /> i <br /> c �� <br /> n. yg� ae & m <br /> CONDITIONS OF PERMIT: o ?, Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. ;f ;1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - - —to y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. : W m <br /> ? S : D <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- O C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- m"' i M <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- `.b' it <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this sp- ' <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have - <br /> � : o: <br /> access to the above described promises at any reasonable time for the purpose of inspection. e <br /> SIGN HERE ~ w <br /> (signature of owner or building contractor) (date) fe <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PE MITS MAY BE REOUIRED12T <br /> o XZSN Snt <br /> 8888898$ w <br />