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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator �, o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> m a <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and H <br /> located as shown herein. The u ersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordina ice,Sanitation Code, and with all other applicable County Ordinances and the laws and . n <br /> regulations of the State of Wiscoi isin. y m <br /> m � <br /> OWNER AST SL TELEPHONE o <br /> ADDRESS A box 12 J- UCCRT LL- t]/ I\/Y) m n <br /> EMERGENCY/FIRE NUMBER ROAD NAME -71 <br /> LEGAL DESCRIPTION (see tax race pt)S N -I-10 — !S <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/E UILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> ,X! o <br /> SANITARY / \ PRIVY FILLING/ RADING CAMPING UNIT SUBDIVISION o <br /> o r <br /> STRUCTURE/ADDITION USE: � <br /> Home/Cabin;Comm cial Business; Bedroom: Deck;etc.) 2 p <br /> 0 0 �• <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 thew II (W), septic tank (ST),and drainfield (DF). <br /> 3. Show dimensions infest of afollowing:(a)building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordinar I high water mark of lake,stream, or river. 011v, <br /> 4. If separate plans are submi ed by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCkTIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a m <br /> 71 Z `v <br /> PLOT PLAN o n <br /> fn o <br /> M <br /> _ z <br /> o <br /> O <br /> N <br /> 0. <br /> 3-1 <br /> o � <br /> N <br /> 1 Z <br /> r� <br /> m c�mg aIn <br /> 0In <br /> D Tb m <br /> CONDITIONS OF PERMIT: ^ < y': `S <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p �Q <br /> 2. REMOVAL OR CUTTING CIF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> H: <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. jj. o c 2 P m <br /> Lr <br /> I declare that this application(fitcluding any accompanying schedule)has been examined by me and to the best of my know1- 0: C <br /> edge and belief it is true,correctand complete.I acknowledge that I am responsible for the detail and accuracy of all informa- «�m m <br /> tion contained in this applicati n(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be telied 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 em providing in this a - en <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have O v <br /> access to the above described premises at any reasonable time for the purpose of inspection. m m xn <br /> l A m m <br /> SIGN HERE c (date) o , <br /> ZONING ADMINISTRATORX XR 'x <br /> TOWNSHIP PE MITS MAY BE REQUIRED 'b <br /> ooba+ b Him <br /> 000mo <br /> ea <br /> 0 <br />