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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Admi StfBtOt N 1 Z <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work coact ibed and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremei its of the m S <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the awe and W <br /> regulations of the Stale of Wisconsin. - <br /> 'o <br /> OWNER ! ✓�O/l� �f�� nOS TELEPHONE .-��� n / O <br /> r o <br /> ADDRESS , , CLLR, <br /> c Te J <br /> EMERGENCY/FIRE NUMBER 2 dC� ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR 1 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE__ ADDITION <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ,' r <br /> STRUCTUREADDITION USE: � � � y� o T <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z v <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) -o <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 drainfieid (DF). �) 5 <br /> 3. Showdimenslons Infest of thefollowing:(a)building to all lot lines,(b)bulldingtocenter line ofroad,(c) building <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 A <br /> dated by the owner. C <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE IE SUED. 9I o N <br /> PLOT PLAN A o n <br /> N o <br /> C r <br /> In � <br /> r <br /> G <br /> I � <br /> 0 <br /> 5�� atIT4 CIQ�D <br /> N ~ <br /> G <br /> Z <br /> D <br /> ) <br /> ro> rn <br /> t7 � <br /> m. mg�Z Cg <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F -I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHOREIAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r" <br /> m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 0 >a <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- ,T_�C) «•m m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that t is infor. v iS B C <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a lermit. 1 gr$ <br /> further accept all liability which maybe a result of the County of Burnett relying on this information I am providing in this ap. VV <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have o <br /> access to the above de premises at any le time for the purpose of inspection. - _ <br /> SIGN HERE S-A <br /> CC a: <br /> f! <br /> (signature of owner or u id tr t ate) j iI <br /> 4 <br /> ZONING ADMINISTRATOR ; <br /> MN N. N <br /> TOWNSHIP FURMITS MAY BE REQUIRED <br /> 88 8 8w <br /> �7eN -0j <br />-- g <br />