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on a')1-\-e <br /> Burnett Courtly 7410 Co. Rif. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w M o a <br /> APPLICATION FOR - LAND USE - PERMITS 3_ 0 <br /> 0 <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 e <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 Wiscor sin. N ' <br /> c <br /> 7 n O <br /> OWNE !JD � TELEPHONE /2_ A L�-3� /� <br /> m <br /> ADDRESS -�-� <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax recei t) <br /> CONTRACTOR �I <br /> (�f <br /> TYPE OF PERM T( : DWELLING/ ILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION o 1 1 ) <br /> 61 <br /> SANITARY PRIVY FILLING <br /> CAMPING UNIT SUBDIVISION <br /> 0 <br /> . WOI I I r 6 + y� N <br /> STRUCTURE/ADDITION USE: I ��"t ��f 'J I 1 ° � <br /> Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z o -, <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) I V <br /> 1. Show the location and size A all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> 2. Show the location of thew II (W),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions in feet oft efollowing:(a) building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordinar., 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. 0o <br /> NOTE: BUILDING/STRUCTURE LO TIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a N <br /> c <br /> 0 0 <br /> PLOT PLAN o n <br /> m N <br /> ' 0 I <br /> 0 <br /> �4 N <br /> N <br /> r 4 d Ilk- <br /> 3 <br /> C3Z � <br /> O <br /> 2° of <br /> CONDITIONS OF PERMIT: i o m j Q L . ro -I <br /> 1, DRIVEWAY MUST MEET D IVEWAY WID EOUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. M <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o a °OD <br /> a : : C <br /> 1 declare that this application(ii cluding any accompanying schedule)has been examined by me and to the best of my knowl- f o . = m m <br /> edge and belief it is true,coned and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- rn ro o m <br /> tion contained in this applicati (including any accompanying schedule)and I further declare that I recognize that this infor. bn is o : p <br /> mation I am providing will be mlied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 o� o <br /> further accept all liability which may be aresult of the Count f Burnett relying on this information I am providing in this ap- <br /> plication. I agree to permit cou ty officials charge with i istering county ordinances or other authorized person to have i O N o: <br /> access to the above de ed remise a any o le time for the purpose of inspection. m 3 'oo <br /> ry 0 A N <br /> SIGN HERE <br /> (sire of ovInAw Dr buil 1 ort - _ (date). J.. <br /> ZONING ADMINISTRATOR <br /> MAY 7 <br /> rnw n aaa T <br /> ` r n N N N N N <br /> TOWNSHIP PERMITS MAY BE REQUIRED m( o v u . v u O In <br /> II o00 $ $ °o N <br /> 8) <br />