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13umett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o c <br /> APPLICATION FOR - LAND USE - PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. o <br /> w <br /> OWNER 7l / A/ ,f,s` / TELEPHONE �61f� g17_0�/ o E <br /> f1 �P�QVrii �Y a1S 96�_.�l 4/dH \\\ G `7 nC� <br /> ADDRESS ,,@ v <br /> ' A rj" r� <br /> EMERGENCY/FIRE NUMBER <br /> '37,575- ROAD NAME <br /> -,4f, <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR j'— <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION " _ p <br /> n o <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION ? <br /> STRUCTURE/ADDITION USE: '�.e0414 /J10PP Dqf,h o <br /> (Home/Cabin; mmercial Business;Bedroo ;Deck;etc. <br /> Z o <br /> o c <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 drainfield (DF). I o <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 <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a y <br /> PLOT PLANz c <br /> A o n <br /> m y <br /> 0 <br /> c � <br /> I <br /> O <br /> SJ <br /> ^'C <br /> 0 <br /> o <br /> D rnN V .0 mo <br /> OW c� . m m ag m <br /> a <br /> CONDITIONS OF PERMIT: o � � 3 <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F m3 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ =� i m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m c C <br /> g E E <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o 1D o 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- m O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor m <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 person to have O0 o <br /> access to the above described premises at any reasonable time for the purpose of inspection. °i 8 <br /> T V A <br /> SIGN HERE 91 <br /> w a <br /> (Si at a of own building contractor) (date) <br /> o : <br /> ZONING ADMINISTRATOR 'C • i $ I <br /> TOWNSHIP PERMITS MAY BE REOUIRED O NN O.8 N H m <br /> N N in m <br /> 8888888 in <br />