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CoBnty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Admin trator E o <br /> APPLICATION FOR — LAND USE — PERMITS w <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and o c <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 awe and o n <br /> regulations of the State of Wisconsin. <br /> c m <br /> 0 <br /> tDD <br /> RWMT��5 <br /> ELEPHONE01ESS ) aSs ,� , KFiSUR <br /> EMERGENCY/FIRE NUMBER ROAD NAME S•' <br /> � � G <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR -0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION �� o <br /> n 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION °. <br /> m � <br /> ° r <br /> STRUCTUREJADDITION USE: v <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z o <br /> 0 v <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) V� <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N).2. Show the location of the well (Vi),septic tank (ST),and drainfield (11 <br /> 3. Show dimensions in feet 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. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and O 0 <br /> dated by the owner. 3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSIfE VERIFICATION BEFORE A PERMIT CAN B SSUED. 2 `c <br /> p n I <br /> PLOT PLAN M o' I71 <br /> C of <br /> 1111�G�Ep W I <br /> 5 <br /> 0 <br /> o <br /> w <br /> m <br /> O ti <br /> o I� <br /> � 2. <br /> Viz:: r <br /> CONDITIONS OF PERMIT: Z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f 5 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Z+ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the be It of my knowl- o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracyof all informs- of <br /> tion contained In this application(including any accompanying schedule)and I further declare that I recogniz that this infor- 8� 8 <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to i sue a permit I <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am prov ding In this ap- <br /> access t Ithe above described promiseslat anyged with reasonable administering <br /> the punty ordinances or rpose of insppectionher authorized person to have <br /> 0T : <br /> _57Qm <br /> SIGN HERE " (d e) <br /> «' <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED ?;na o u,"M 8 T,9 <br /> $ $$ $8888 <br />