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(V (W, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ,N, m o 0 <br /> 'APPLICATION FOR — LAND USE — PERMITS 3' <br /> d o <br /> TO THE ZONJUG ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <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 <br /> regulations of the State of Wisconsin. N 0 <br /> c r? <br /> m O <br /> /r TELEPHONE n F <br /> OWNER lJ'�C�CJ1`I` ��LLS � ] Q o m <br /> ADDRESS (jq0 MAIW IDA�]30K <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> I <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYP --PERMII(S)) DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O <br /> G) <br /> SANITARY� RIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> '^ r <br /> STRUCTURE/ADDITION USE: ° <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z o <br /> } <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). 0) <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions infeet of thefollowing:(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 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a m <br /> PLOT PLAN z `v <br /> P o <br /> m o <br /> H I ] I <br /> M�ROG m <br /> I in <br /> ° <br /> 0 <br /> N r� <br /> J <br /> m <br /> O -y <br /> N <br /> 2 <br /> CV <br /> c�0i r- 0 a:E m <br /> m am—g� e'r c = 33 <br /> 3 -. W y <br /> CONDITIONS OF PERMIT, ^ < m'; 12 ]ro r. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 0 �_ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N W <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` !" O m <br /> IF <br /> I declare that this application(including 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- «ry«. m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 8a g p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I oi o <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this ap- d, <br /> plication.I agree to permit County officials Charged with administering county ordinances or other authorized person to haveO p <br /> access to the above described premises at any reasonable time for the purpose of inspection. In 3 bo R- <br /> m m A N <br /> SIGN HERE t� -" M - u N c i <br /> (signatur of owner or building contractor) j! I ' _� - .04te) pp <br /> T " IV <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED ' I N N m <br />