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Bumstt County 7410 Co. Rd. K, No. 102, Siren,WI 54672 Office of Zoning Administrator I Z <br /> APPLICATION FOR - LAND USE - PERMITS ° <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and a ° <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the a '-T\ <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. - c <br /> m m_ <br /> OWNER �. ' �/ $ O <br /> •1 TELEPHONE (,Z - E <br /> 7 - icy `� <br /> ADDRESS 1'•� >°C->L L/�-,CQ� n m mom' <br /> C� 7 �'t >f I s, �t S <br /> EMERGENCY/FIRE NUMBER <br /> ROAD NAME <br /> L7 GP � <br /> LEGAL DESCRIPTION (see tax receipt) '7 _ �� F <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> 0 <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> STRUCTURE/ADDITION USE: ( C 0 e " r <br /> a o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) IM <br /> Z o <br /> o v <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) I .� <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate Nort (N). <br /> 2. Show the location of the well (N),septic tank (ST), and drainfield (DF). 5 <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 sighed and <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 'w a <br /> y <br /> PLOT PLAN <br /> (V/ 0 <br /> f4 C O <br /> N <br /> 2/00" <br /> z <br /> s <br /> �'j f <br /> CONDITIONS OF PERMIT: o. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z o'�': ti Z i <br /> ac <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. L" p O i m <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- QQ •` E • C <br /> • o; E C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all i forms- <br /> IT! <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that thi infor- E B S m <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue■ rmlt. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information I he providing in his t. I <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person o have p <br /> access to the above described premises at any reasonable time for the purpose of Inspection. R <br /> C m <br /> SIGN HERE . a . <br /> (signatu�ow r or building contractor) (date / 'ti ' �' <br /> 1 <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED m <br /> $ 888888 umi <br />