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Burnett County,7410 Co. F d. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m o c <br /> APPLI ATION FOR - LAND USE - PERMITS - <br /> TO THE ZONING ADMINISTRA OR:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The u idersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordini nce,Sanitation Code, and with all other applicable County Ordinances and the laws and a <br /> regulations of the State of Wiscc isin. m m <br /> c <br /> O <br /> OWNERp - / _ TELEPHONE <br /> I t <br /> al- <br /> r— W G <br /> ADDRESS 7 S 3 �. rAZ , �I <br /> EMERGENCY/FIRE NUMBER `�. S ROAD NAME <br /> LEGAL DESCRIPTION (see tax ret ipt) <br /> CONTRACTOR � ! J ; � -}-- <br /> ac <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 /> r <br /> STRUCTURE/ADDITION USE: . We ° o <br /> v <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z o <br /> o c <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 /> r <br /> 2. Show the location of thew II (W),septic tank (ST), and drainfield (DIF). 3 <br /> 3. Show dimensions in feet of I hefollowing:(a)bulldingto all lot lines,(b)buildingto center line of road,(c)building _ <br /> measurement to the ordina y high water mark of lake,stream,or river. <br /> 4. If separate plans are submi led by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. C o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSFE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '11 3 w 7C <br /> PLOT PLAN <br /> fill <br /> � a� <br /> - <br /> M � V = <br /> re�u,w Pere�/ O <br /> 2 <br /> COrvr,•'JSQ 1>50°/a ucrea+� n <br /> \\\ C <br /> S <br /> J <br /> q:ndc - I�`t89 <br /> N — <br /> 0 <br /> p <br /> - m <br /> de, <br /> !� If art <br /> !� <br /> f <br /> a <br /> XI <br /> CONDITIONS OF PERMIT: 5, <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. = m o ' <br /> o 'H <br /> £ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. y^, <br /> 3. NO GRADING OR SHOR LAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. u' ° Q <br /> Si <br /> ge : <br /> I declare that this application(ncluding any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,torr t and complete.1 acknowledge that I am respopsible for the detail and accuracy of all informs- «m m <br /> tion contained in this applicati Dn(including any accompanying schedule)and.1.further declare that I recognize that this infor- B p <br /> motion 1 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 whit i 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 cot my officials charged with administering county ordinances or other authorized person to have <br /> access to the above describett premises at any reasonable time for the purpose of inspection. m <br /> m <br /> i $ y <br /> SIGN HEREw; N <br /> / :m <br /> (s p ur of owner or Ing contractor) (date) F i i im <br /> x <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 000 a N 0 m <br /> L bb oo�� apot y <br /> an <br /> a <br />