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N cb <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54672 Office of Zoning Administrator W m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3_ o j <br /> d <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 0 n <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regul[ IS of the State of Wisconsin. <br /> N d <br /> w � <br /> m O <br /> OWNER © p E f< IJTO L TELEPHONE <br /> ADDRESS 5 1' QV co , FD A l 6_&SCEg W I- 59993 <br /> EMERGENCY/FIRE NUMBER ROAD NAME `FT <br /> l (lyl)I <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> OF FERMI DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> 0 <br /> o ° <br /> STRUCTURE/ADDITION USE: T <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) OZ o <br /> 0 <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 (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 -4 O <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 <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 91 a w <br /> 7I Z <br /> PLOT PLAN 0 n <br /> 0 <br /> m � o <br /> cw <br /> �'ACk�ElO 0 <br /> cS� <br /> lJ �' <br /> 0 <br /> O Illl7`J�7\`I`) <br /> 7 <br /> O � <br /> I� <br /> Z <br /> N <br /> I� <br /> f <br /> a ��mrnr DD F <br /> CONDITIONS OF PERMIT: G ?; 8 . ro i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 1 NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. U1 OE i m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- Ri i <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- m <br /> tion contained in this application(including any accompanying schedule)and 1 further declare that I recognize that this infor- a 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 o big 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.1 agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> ucess to the above described premises at any reasonable time for the purpose of inspection. <br /> In 3 c <br /> m : A N <br /> m g : <br /> V HERE <br /> (signature df owner or buil 'n con racta a <br /> i ADMINISTRATOR F.IL7 <br /> I ` 8 <br /> TOWNSHIP P RMITS MAY BE REQUIRE " �" m <br /> 0oo U) <br />