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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m 4 o <br /> APPLICATION FOR — LAND USE — PERMITS 2. 2 <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes m o <br /> g by application for a Permit for the work descri and � a <br /> located 85 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 I Ns and (N <br /> regulations of the State of Wisconsin. <br /> u <br /> c O <br /> OWNER - TELEPHONE :770 a <br /> m O m <br /> ADDRESS o <br /> EMERGENCY/FIRE NUMBER 7 ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) " <br /> / <br /> CONTRACTOR _ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p y <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo 0 <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z o <br /> 0 o <br /> 3 <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 (N),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road, (c) wilding <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 Sig ied and <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. an v N <br /> PLOT PLAN o <br /> n o a <br /> A GC� c o <br /> 4 CA y <br /> n M c <br /> co^�:�=oma � F ��'S-�,. � I r✓ <br /> O ) e <br /> II N IV v <br /> N <br /> I� <br /> Z <br /> ii ln� 0 ag m <br /> g a_ <br /> 37 <br /> CONDITIONS OF PERMIT: = < m' •Z C r$ g� �+ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e 0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. v1 N 2j2 <br /> ' D <br /> 000g � : <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of ny knowl- �` g <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- N m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this Infor- <br /> mation 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 providing n this ap- <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have I. m. o i <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 <br /> e <br /> SIGN MERE <br /> (signature of o n Idin cont t q (date) N <br /> ZONING ADMINISTRATOR ' <br /> IV <br /> g E f <br /> TOWNSNI ERMITS MAY BE REQUIRED O CAM <br /> N -nq M rN�NN+ <br /> N N p N N m <br />