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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54672 Office of Zoning Admfnl�trator -d m o o <br /> APPLICATION FOR — LAND USE — PERMITS m ' <br /> TO The ZONIN&ADMINISTRATOR:The here undersigned g by makes application for a Permit for the work described and � v <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 laws and , 1 <br /> regulations of the Stale of Wisconsin. m m 11 j <br /> C m <br /> $ F <br /> OWNER -jig <br /> TELEPHONE 3 70 12 <br /> m <br /> ADDRESS <br /> c- <br /> EMERGENCY/FIRE NUMBER ROAD NAMELiz <br /> J <br /> - � u <br /> LEGAL DESCRIPTION (see tau receipt) /. ,y O <br /> CONTRACTOR ( f O ✓G/ f��' D �� �L� �K� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGElACCESSORY STRUCTURE ADDITION o <br /> SANITARY PRIVY FILL lGRA ING CAMPING UNIT SUBDIVISIONo <br /> o <br /> J <br /> STRUCTURE/ADDITION USE: g <br /> (Ho a/Cabin'Commercial Business; Bedroom;Deck;etc.) z o <br /> o c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) ` r <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate Nort i (N). r <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). g <br /> 3. Show dimensions In feet of thefollowing:(a) buildingto all lot lines,(b)bulidingto center line of road,(c)building an <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 <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSFrE VERIFICATION BEFORE A PERMIT CAN BE UED.� 111 a m <br /> PLOT PLAN ? Z <br /> (Yl <br /> N <br /> a <br /> � I <br /> .1:1 <br /> N <br /> pe r <br /> 33 g � in��'99Dfm <br /> a $e : - <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c <br /> 0 e '� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. J ` i rn <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ? r$" G <br /> r 0 ` C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best o my knowl- 4 <br /> comp late.I acknowledge that I am responsible for the detail and accuracy of II informs- ". <br /> edge and belief it is true,correct and comIn <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize the this infor- <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providinj in this ap- <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized pan on to have <br /> access to the above described premises at any reasonable time for the purpose of Inspection. T <br /> ---f.- w <br /> SIGN HERE ' � w <br /> (signature of owns o ullding contr ton <br /> �r- (d I ) 4 r <br /> ZONING ADMINISTRATORS E <br /> �Ji: 8 : <br /> TOWNSHIP PERMITS MAY BE REQUIRED II',,1 JN, o N E R oNi a E m <br /> 88888888w <br /> a�— <br />