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o gip, <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 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m F <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws andregulations of the State of Wisconsin. ° <br /> N <br /> C <br /> OWNER o� / <br /> ADDRESS <br /> r �.! <br /> EMERGENCY/FIRE NUMBER /y r� ROAD NAME (CIC <br /> LEGAL DESCRIPTION (seetaxreceipt) `_/- 24 /� p' l? /0r�,,cC / ,1 <br /> CONTRACTOR T 4 te <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> o 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 ° <br /> o m` <br /> STRUCTURE/ADDITION USE: °— <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z m <br /> O ° <br /> 0 <br /> m <br /> 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 ofthefollowing:(a) building to all lot lines,(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 <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 c N <br /> PLOT PLAN Z o <br /> nP a <br /> m <br /> Gt✓ � ' <br /> 0 <br /> J <br /> N � 1 <br /> O v <br /> J <br /> J <br /> Q � <br /> N <br /> ^ I� <br /> Z <br /> O_c M 0 o.f <br /> Dg� 2a2 g-m 37 <br /> CONDITIONS OF PERMIT: v S.: c 8 S� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o I o :� � i i -1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N 77 <br /> N : <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 25 2 m <br /> ° <br /> o : ff : E D <br /> I 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- i ir^m"' T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- ra B g p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 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- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have Oa p <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 3 'oo 0 <br /> RL i <br /> 0 0 A N : <br /> l' M v Oy <br /> SIGN HERE / - i ` - <br /> (signature 'o er r wilding actor) f-'� 2 i'1 �t6) ; E : <br /> �f , o : x[ <br /> ZONING ADMINISTRATOR ! !- ` <br /> �. . <br /> T WNSHIP PERMITS MAY BE REQUIRED !I r 9 p N N N N N6-n <br /> j 8 $ 8888 <br />