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(� cep <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> d 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and in <br /> m c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State of Wisconsin. y <br /> m :c <br /> OWNER TELEPHONE FO <br /> At�(�� LR SoTA <br /> ADDRESSS _KIKG X0 _ "R.o tLlt I ��_ (off 1')2. <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (seetaxreceipt) <br /> I <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p (2J <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` <br /> o <br /> �.,,L ' r <br /> STRUCTURE/ADDITION USE: IILA/I�SA'1 /� o 0 <br /> (Home/Cabin;Commercial Business;Be room;Deck;etc.) Z <br /> 0 0 <br /> 0 <br /> m <br /> 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) rA " <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 of the following:(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 O <br /> O <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 o N <br /> c <br /> PLOT PLAN n o a <br /> M I <br /> m <br /> b <br /> 1 <br /> N <br /> O <br /> YJ <br /> O <br /> 0 <br /> O <br /> H <br /> Z <br /> S <br /> D o c m m a Do. : m <br /> CONDITIONS OF PERMIT: <br /> o 0 < : Z m o 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F T� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ ^' m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m C <br /> $ C <br /> Q <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o l 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 informs- w m w O <br /> tion contained in this application(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 <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- N <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have v, p <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> 89 : <br /> T A x <br /> I <br /> SIGN HERE44A r `_` m g <br /> (sign ure of owner or�buuilding contractor) (date) p t . <br /> ZONING ADMINISTRATOR `�7 YLA7.{IC'�NT1 ,3 O 1992 <br /> TOWNSHIP PERMITS MAY BE REQUIREDN m <br /> N N <br /> OO m <br /> 888 8888m <br />