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c <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 4 c <br /> APPLICATION FOR — LAND USE — PERMITS m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the $ 7 <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and _ o <br /> regulations of the State of Wisconsin. m <br /> w m r <br /> p rTELEPHONE <br /> c V <br /> OWNER � BI TELEPHONE n E <br /> ADDRESS So 17-56) NW�I 36 TRN F>U" \41 - 54 `330 <br /> EMERGENCY/FIRE NUMBER ROAD NAME r0- <br /> LEGAL DESCRIPTION (see tax receipt) I <br /> CONTRACTOR 01- <br /> TYPE <br /> TTYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION �- <br /> O <br /> `yn n G7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o a � <br /> STRUCTURE/ADDITION USE: o o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) <br /> Z <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). 5 <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 ordinary high water mark of lake, stream, or river. <br /> 4. it separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 3 N <br /> PLOT PLAN o 'a \ <br /> A s C <br /> M <br /> C U ' ) <br /> u �ss <br /> (J <br /> u Q) <br /> 0 o <br /> c <br /> s <br /> O y <br /> K 4E <br /> N <br /> Ir <br /> Z <br /> f <br /> K�2. m <br /> CONDITIONS OF PERMIT: <br /> I <br /> iQCSNCHC <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z e S.I - SQ =I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P f ' - N X1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED.' O i m <br /> 5 <br /> I declarethat this application(Including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> : o l E : <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informs- i •+m w f <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing in this ap- <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have O <br /> access to the above described premises at any reasonable time for the purpose of inspection. m ' <br /> - <br /> z �69s <br /> SIGN MERE ~ a <br /> (s (date) <br /> ZONING ADMINISTRATOR <br /> y <br /> TOWNS PERMITS MAY BE REOUIRED 0»N N MM Nom+ Mt <br /> � N m <br /> $ $ $ 88880 <br />