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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d o 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 9 m r , <br /> located tts 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 3 a <br /> regulations of the State of Wisconsin. <br /> OWNER ��/� (� / / TELEPHONE n FO <br /> m <br /> m_ _ m <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER '/ S ROAD NAMEG,Ld <br /> LEGAL DESCRIPTION (see tax receipt) r M 7�✓ <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION / <br /> O <br /> n0 <br /> SANITARY PRIVYFILLnnINgqG/AAGRADING CAMPING UNIT SUBDIVISION o` <br /> STRUCTURE/ADDITION USE: _ (.JQ Orr) y o <br /> 0 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> 0 0 <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) '3< <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). <br /> 3. Show dimensions infeet of the following:(a) building to all lot lines,(b)buildingto center line of road,(c)building <br /> measurement to the ordinary high water mark of lake, stream, or river. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. 0 <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 0 a <n <br /> c <br /> PLOT PLAN —,¢,a}�5�T ( /_� � �/ <br /> Z <br /> x`-`r � 0 0 <br /> fn o <br /> c <br /> m <br /> JJ.s,e�, <br /> / I raiwa� <br /> JV <br /> Ic ��� r6I �{Isr7Wv yi <br /> 3Gr <br /> /obe,/lb ihs,llC, f�aT�fi..� <br /> Z <br /> i <br /> nde Com�'�i4n� <br /> Sys / in , I <br /> 7� See a 4C It, <br /> o c m m o a m <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a E a NZQ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. fl21 »' m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. am c a <br /> 8 a <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- '� o I a m `� a <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- O <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 th County of Burnett Wisconsin in determining whether to issue a permit. I ,�`''„8 8 <br /> W <br /> further accept al i ilit which may be a result the County of Burnett relying on this information I am providing in this ap- <br /> plication. I agr t per t county of i 1 d with administering county ordinances or other authoriz d perso to have O ut p <br /> access to the o ed re Tse reasonable time for the purpose of inspection. 3 8 <br /> rmj V A a i <br /> SIGN HER <br /> (si nature of owher or building contractor) (date) <br /> a <br /> s ; <br /> ZONING ADMINISTRATOR / <br /> (O <br /> K <br /> p . . <br /> TOWNSHIP PERMITS MAYTE REQUIRED H(ll UI N <br /> . P 4 N 8. 8 g mm <br /> 88888888rn <br />