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&A We v p) <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d 10 0 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 mc <br /> located as shown herein. The ndersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordi ante,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wi :)nsin. �, m <br /> c m <br /> O <br /> `T PHONE <br /> _ m <br /> ADDRESS�_7� J ` -1,v 'h at <br /> // 6 <br /> EMERGENCY/FIRE NUMBER ROAD NA <br /> LEGAL DESCRIPTION (see tax re eipt) <br /> CONTRACTOR f <br /> TYPE OF PERMIT(S): DWELLING BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p 1 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> J 1 � <br /> '^ r <br /> STRUCTURE/ADDITION USE: o ° <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z m <br /> o ° <br /> a <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and siz of all existing buildings (EB) and all new buildings (NB) and indicate North (N). <br /> 2. Show the location of the vrell (W),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)building <br /> measurement to the ordini ry high water mark of lake, stream, or river. <br /> 4. If separate plans are subm tied by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE L TIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I 3 N <br /> c <br /> PLOT PLAN o c <br /> m <br /> m <br /> U1 <br /> f N <br /> O <br /> J <br /> —1 - N <br /> �_— ° V <br /> ji <br /> J <br /> 41- <br /> C m <br /> r 1 <br /> Z <br /> 1 <br /> r�ain � m <br /> m. DSS <br /> Pane am <br /> CONDITIONS OF PERMIT: g Q CS NO M <br /> 1. DRIVEWAY MUST MEET MRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c W Q <br /> if <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORE LAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. b °L, O <br /> I declare that this application(ncluding any accompanying schedule)has been examined by me and to the best of my knowl- o <br /> gFD c <br /> edge and belief it is true,corre t and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this a licati n(including an accompanyingschedule)and I further declare that I recognize that this infor- B <br /> PP (� 9 Y g O <br /> matlon 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 o`� <br /> further accept all liability whit i 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 coL nty officials charged with administering county ordinances or other authorized person to have i O N 0 <br /> access to the above describec premises at any reasonable time for the purpose of inspection. T 3 go <br /> N <br /> SIGN HERO �,.ea.(/U, C <br /> (s gnature of owner or building contract r) ` (date) xa <br /> (n ' <br /> ZONING ADMINISTRATOR 8i <br /> k <br /> wxrwu+g(nx T <br /> TOWNSHIP PERMITS MAY BE REQUIRED > N !A f% N m <br /> 000 o m <br /> 0 <br />