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Ce/w_ <br /> Burnett County 7410 Co. R . K, No. 102, Siren, WI 54872 Office of Zoning Administrator w m a 0 <br /> r <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> o <br /> TO THIL ZONING ADMINISTRAT R:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The unc arraigned agrees that all work shall be done in accordance with the requirements of the T m <br /> Burnett County Land Use Ordinan e, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 0. <br /> regulations of the State of Wiscon in. H m <br /> N R <br /> n O <br /> OWNERRDnal .1 L I TELEPHONE o E <br /> m 1D <br /> m' <br /> ADDRESS ri <br /> L_ I -S s/�-r/ i N 5 p\ <br /> EMERGENCY/FIRE NUMBER I ROAD NAME Pj Z <br /> vv <br /> LEGAL DESCRIPTION (see tax recei t) <br /> CONTRACTOR um— <br /> TYPE OF PERMIT(S): DWELLING/B ILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY /\ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo °< <br /> / \ <br /> STRUCTURE/ADDITION USE: ° o <br /> ( ome/Cabin;Commercial Business; Bedroom; Deck;etc.) Z o <br /> 0 0 <br /> m <br /> 3 <br /> DIRECTIONS FOR PLOT PLANDRAWING: (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 in feet ofth following:(a) building to all lot lines,(b)buildingto center line of road,(c)building <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 M <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCA IONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '11 a m <br /> 11 z Q <br /> PLOT PLAN 0 0 o <br /> m <br /> Ci <br /> M -., <br /> I <br /> 0 <br /> 0 y <br /> N <br /> Z <br /> N O.c�M 9 0 o f <br /> $ 9g� aNQmm <br /> MM <br /> CONDITIONS OF PERMIT: '� m' T+ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p £ it'z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =r^ M <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. !n : :o: m <br /> C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- : o : <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- gt m <br /> tion contained in this aDDlicatio (including any accompanying schedule)and I further declare that I recognize that this infor- # <br /> mation 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 ap- y, x <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have i i : O to o <br /> access to the above described premises at any reasonable time for the purpose of inspection. i p1 m <br /> m <br /> SIGN HERE a` N <br /> (sig ature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR I r 8 x <br /> TOWNSHIP PERMITS MAY BE REQUIRED .0 N N N m <br /> 0008 $ $ �xvf <br /> 0 <br />