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6�( 0 <br /> Burnett County 7410 Co. . K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 m o�o <br /> APPLICATION FOR — LAND USE — PERMITS s' <br /> a G <br /> TO THE ZONING ADMINISTRAT R:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The u dersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordine nice,Sanitation Code,and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisc isin. �, m <br /> 4 0 <br /> C <br /> OWNER rTELEPHONE G677 a <br /> r� <br /> ADDRESS [ L Q <br /> c- 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> G <br /> LEGAL DESCRIPTION (see tau rec pt) �l <br /> CONTRACTOR _ tic <br /> (- <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION p ^i <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a <br /> /'I .TICAae lv <br /> I ' 0 <br /> l'�` <br /> STRUCTURE/ADDITION USE: <br /> Home/Cabin;Commercial Business;Bedroom; Deck;etc.) z v <br /> 0 0 <br /> v <br /> m <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 wc II (W),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions In feet oft a following:(a) building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordinarf 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 9 <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOG kTIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1A o y <br /> 1A cv <br /> PLOT PLAN z <br /> N /� L ✓�' �� A o ? zr <br /> 4� c 0 <br /> c <br /> �cc <br /> C— <br /> by <br /> d <br /> d�-le ld 33 L Cw�h i � <br /> or <br /> iC��'v " r• � z <br /> z <br /> f <br /> R TT-L',>&fm <br /> a. $� ITa� "- 70 <br /> CONDITIONS OF PERMIT: ^ ��. Z co S� � <br /> 1. DRIVEWAY MUST MEET 0141VEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING O TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P E gN a <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ' r" ' O 25 '• m <br /> I declare that this application ir cluding any accompanying schedule)has been examined by me and to the best of my knowl oi C <br /> edge and belief it is true,correc and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- I •`m"i T <br /> tion contained in this applicatio (including any accompanying schedule)and I further declare that I recognize that this infor B `. p <br /> mation I am providing will be lied 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 cou y officials charged with administering county ordinances or other authorized person to have - <br /> access to the above described <br /> at <br /> at any reasonable time for the purpose of inspection. <br /> T y : <br /> O M <br /> SIGN HERE E w' <br /> (sl nature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR E 8E <br /> TOWNSHIP PERMITS MAY BE REQUIRED o �8 A Nla'Lb m <br /> 888888,88 rn <br />