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on") <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54072 Office of Zoning Administrator m m o O <br /> f <br /> APPLICATION FOR - LAND USE - PERMITS m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work clescl 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. w m <br /> c m <br /> a / O <br /> OWNER Q q A T� �� 1 TELEPHONE <br /> ADDRESS l SS f 11�/ rron <br /> EMERGENCY/FIRE NUMBER ROAD NAME ) <br /> LEGAL DESCRIPTION (see tax receipt) & / 15e0t10 ' <br /> CONTRACTOR A/OEJZS0A1 <br /> y <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O <br /> n L) <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> ° < <br /> STRUCTURE/ADDITION USE: OSe 0 x it ) H <br /> 0 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z e <br /> o a <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 (VV),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. 0 <br /> 4. N separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sig ed and <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I 3 rn <br /> PLOT PLAN See S;w- A Z Cr <br /> zll- r? 1LIy o <br /> C � <br /> OM <br /> 0 <br /> ur <br /> p, o <br /> IIS <br /> oQQ <br /> I J <br /> IL_ <br /> O y <br /> N Ik <br /> = 1� <br /> Z <br /> \ T! <br /> S ba fnv�nr DD O y <br /> 2. MM <br /> m <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <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. '>Ij " i ° O 25 m <br /> i ai P C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of y knowl- E <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of a I informs- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this Infor- � <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue & permit. I •vx <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this so- i E . <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized portion to have 0: <br /> access to the above described promises at any reasonable time for the purpose of Inspection. <br /> m <br /> _ <br /> SIGN HER <br /> (sig (date) <br /> t ro of o e or Dullding contractor) <br /> ZONING ADMINISTRATOR <br /> nM MM+�Mfi1HyOq Zt <br /> TOWNSHIP PERMITS MAY BE REOUIRED o N N $N 5 N m <br /> $ 888888$ vmi <br />