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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Adrryinistrator ( m f c <br /> APPLICATION FOR - LAND USE - PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 91 <br /> 91 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the require ems 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 /> eN m <br /> c <br /> OWNER A )�Ck ( ,.`� i.\ TELEPHONE O <br /> ADDRESS/// X '7�,�f� m <br /> C � <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> r <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UIT <br /> SFI SU�BDIJVS-fION <br /> STRUCTURE/ADDITION USE: � 1� <br /> � o0� <br /> ° <br /> (Home/Cabin;C ercial Business;Bedroom; Deck;etc.) i v <br /> Z o <br /> 0 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 drainfield (DF). <br /> 3. Show dimensions Infest of the following:(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 signed and M w <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 0 e <br /> PLOT PLAN 11 Z u <br /> c <br /> A o n <br /> O <br /> C = <br /> OA <br /> M L) <br /> IN <br /> G� <br /> ^� m <br /> V V = <br /> o <br /> 2. IN <br /> 0 <br /> A <br /> / <br /> of 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. Li gg In <br /> V`'} E <br /> �• Lr ` ? C_ <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best ofy knowl- S , <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- a a <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this <br /> infor. m <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue permit. 1 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing n this ap- - 8 8 <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for theu <br /> p rPoae of inspection. <br /> m ; ? 72 <br /> m <br /> SIGN HERE w <br /> (signature of owner orb ilding COMMA (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP ITS MAY E REQUIRED '"« <br /> � 4X N� 9 m <br /> B <br /> 888888 um) <br />