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6�(' C"J <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> 0 <br /> TO THE ZONING 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 `m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a Q <br /> regulations of the State of Wisconsin. m <br /> N � h�f <br /> OWNER y �^`1 n n W O <br /> � ]�. / �/(4A��9V�j1�.(�' �7 0 r �7 TyE�LE`P'HONE® /_". �M _. 'ZI Ej o <br /> ADDRESS �� � /if SC 9091 5s-rFe IF I l I� P�j�<--al n <br /> EMERGENCY/FIRE NUMBER ROAD NAME Q \v l <br /> LEGAL DESCRIPTION (see tax receipt) � ---� <br /> y <br /> I <br /> CONTRACTOR <br /> L <br /> E MIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITIONITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION p 0 1 n <br /> o <br /> STRUCTURE/ADDITION USE: u 0 V <br /> o <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 4 <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 (W),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions infeet of thefollowing:(a) buildingto all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordinary high water mark of lake, stream,or river. 0 V <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 'A <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on 3 O <br /> 11 z Q <br /> PLOT PLAN <br /> o n <br /> In —F o <br /> ci <br /> m sv Qn = <br /> IN <br /> n <br /> o <br /> N Y 1A <br /> IVv <br /> 7 f v <br /> ! Z <br /> IPpI' <br /> �I <br /> , I / /S /er <br /> `', f <br /> 0 M r 0 a Oa <br /> — �� <br /> fir 0 <br /> CONDITIONS OF PERMIT: a00N c- <br /> m '- m— 9 <br /> m N.: `z C O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c f 0 Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1� _»�: M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. -i—: .'«" : O 2 : m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- n: In <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- iii <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 0� 0 <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- <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have Op <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 3 $ 0 <br /> A N <br /> SIGN HERE �'� Ih <br /> - <br /> (signat re of owner or building contractor) , (date) <br /> ZONING ADMINISTRATOR <br /> —O-CT r <br /> TOWNSHIP PERMITS MAY BE REQUIREDo a N N 8 � m <br /> . m <br /> 0000000, t» <br />