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Burnit County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m -0o c <br /> APPLICATION FOR — LAND USE — PERMITS f <br /> m <br /> TO ME ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and , w <br /> locaed as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 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. H m <br /> w � <br /> OWNER J � TELEPHONE �C.��""'N'�� n O <br /> F <br /> w D <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER � Q ROAD NAME ��� LA <br /> LEGAL DESCRIPTION (see tax receipt) go <br /> �J <br /> CONTRACTOR ` ^ lJ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n C) <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> o ° <br /> D <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). <br /> 3. Show dimensions infeet of the following:(a)buildingto all lot lines,(b)buildingto center line of road,(c)building -q <br /> measurement to the ordinary high water mark of lake,stream, or river. 0 <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. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. IN v y <br /> c <br /> PLOT PLAN o n <br /> M o <br /> ci <br /> m <br /> Ueje <br /> tloCAT,51�> AT -r7 <br /> N <br /> O Ily[U` <br /> $120Wr4 '1'P rAA <br /> o <br /> N <br /> It �, <br /> /Uo <br /> tn_ CL-5 6-161e <br /> MO . � dm � ag � <br /> EL E } a M <br /> D _. , m m <br /> CONDITIONS OF PERMIT: � <, ��-,� -2 m o .0 <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E 0 _ IQ � a <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ 0 m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m » : C <br /> g c : <br /> a <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 informa. w m w t7 <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor m cNn <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 $ m 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing in this ap- N <br /> plication. I agree to ermit county offi Is charged with administering county ordinances or other authorized person to have O v, p <br /> access to the abov describe rem' a at any reasonable time for the purpose of inspection. 01 $ l <br /> T A m <br /> M 0 <br /> A pq <br /> q M O V <br /> SIGN HERE Juar <br /> Osl o <br /> /$ig to f ner or contractor) ^_ — r ^i <br /> ZONING ADMINISTRATO '- g <br /> T <br /> TOWNSHIP PERMITS MAY BE REQUIRED.! N u, o a, o In <br /> I <br /> JUL %89999 <br />