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1 <br /> Burnett County 7410 Co. d. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m -V o 0 <br /> APPLI ATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRAT R:The undersigned hereby makes application for a Permit for the work described and 0 c <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 Ordina ce,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisco sin, y <br /> w <br /> C <br /> OWNER TELEPHONE <br /> n O <br /> T <br /> m <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME J/ <br /> a[ � <br /> LEGAL DESCRIPTION (see tax race pt) a e"Sm V , P. <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/ UIL ING GARAGE/ACCESSORY STRUCTURE t1---`ADDITION p / <br /> n 0 G <br /> SANITARY PRIVY FULLING/GRADING CAMPING UNIT SUBDIVISION o ° O�\ <br /> STRUCTURE/ADDITION USE: )6 o ° <br /> Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> a 0 <br /> a <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 thew II (W),septic tank (ST), and drainfield (D17, o <br /> 3. Show dimensions infeet oft efollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)building 11 <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 9 <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE -CaTIONS MUST BE STAKED FOR ONSrTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a m <br /> c <br /> PLOT PLAN Ate, j o a <br /> C I � <br /> t (� <br /> e <br /> o — Ord <br /> z <br /> M <br /> rU r ( <br /> l <br /> Y � <br /> pa ' <br /> 0 a O <br /> � a <br /> 0 <br /> m <br /> am m <br /> CONDITIONS OF PERMIT: - '? ,z L . Q i <br /> 1. DRIVEWAY MUST MEET DR IVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 0 �Q : : --1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =r» <br /> 3. NO GRADING OR SHOREU ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o a ^ O <br /> 0 : <br /> 1 declare that this application(in(luding any accompanying schedule)has been examined by me and to the best of my knowl o m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs' y <br /> m <br /> tion contained in this application (including any accompanying schedule)and I further declare that I recognize that this infor- B . p <br /> mation I am providing will be re led upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liabilitywhich r iay be a result of the County of Burnett relying on this information I am providing in this ap- <br /> plication. I agree to permit count officials charged with administering county ordinances or other authorized person to have <br /> access to the above described pemises at any reasonable time for the purpose of inspection. <br /> n w <br /> -Pe� /ps`- Y-3 <br /> SIGN HERE - � i � <br /> u (date)atr <br /> o x: <br /> ZONING ADMINISTRATOR S <br /> wH4i i yFnT <br /> TOWNSHIP P MITS MAY BE REQUIRED o N N m <br /> oogo $ 000fA <br />