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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m c c <br /> 'APPLICATION FOR - LAND USE - PERMITS <br /> TO THE ZOF41NG ADMINISTRATOR:The undersigned here makes a o <br /> g by application for a Permit for the work described and � v <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. <br /> , u m <br /> O <br /> OWNER QC 4-Q � /J--0£ CJW 1TELEPHONE ry//7— -7 — �Ul1QY�� <br /> O <br /> ADDRESS I D 1 tf 3ov Ave— rr.deri C W1 '5q832 m <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR ,/ ) <br /> TYPE OF PERMIT(S): DWELLING/BUILDING V GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> o <br /> SANITARY /\ PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION <br /> 4 m <br /> STRUCTURE/ADDITION USE: a ° <br /> (Home/Cabin;C mmercial Business;Bedro ;Deck;etc.) Z <br /> 0 0 <br /> 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 the well (W),septic tank (ST),and dralnfield (DF). <br /> 3. Show dimensions In feet of thefollowing:(a)building to all lot lines,(b)building to center line of road,( )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 IIgnetl and <br /> dated by the owner. C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. in o rn <br /> PLOT PLAN _ <br /> o n <br /> 111111 01 <br /> In <br /> I� <br /> y <br /> 0 <br /> Ili <br /> O 1/ 1 <br /> 0 IIIv.I�`I <br /> N <br /> Z <br /> IIII1� <br /> I <br /> G <br /> 3Dfit W DD0 y <br /> g �' v <br /> C �R �f m <br /> 7t7 <br /> CONDITIONS OF PERMIT: <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o 75, - <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - - N M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O1 O m <br /> Li i C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best o f my knowl- o : E ? 9 <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy ol all informs- «m w m <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 accept all liability which may be a result of the County of Burnett relying on this information I am providing in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized pe on to have m` OE <br /> : <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> m 3 <br /> Y signs lane or) K;s 4dvunnni- 16 no+ a waiver o my Cons f+ fi'an er / m <br /> SIGN HERE <br /> (signature of owner or building contractor) ( ate) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED OMM+�MMp+� Zt <br /> Nf� ��N �� m <br /> $ 8 $ $$8 $$ vi <br />