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Viz <br /> Burnett County 7410 Co. Rd K, No. 102, Siren, WI 54872 Office of Zoning Administrator in �m� <br /> APPLICATION FOR — LAND USE — PERMITS0 3 <br /> m a <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v 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 <br /> regulations of the State of Wiscom in. w a <br /> C m <br /> m O <br /> OWNERTELEPHONE <br /> p q- L-'i,o •• •_- m <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME <7L,:1 <br /> I <br /> LEGAL DESCRIPTION (see tax receipt) Of j U 6 ( 3 Ion <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BILDING GARAGE/ACCESSORY STRUCTURE ADDITION o --r <br /> n 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION0 <br /> 0 <br /> STRUCTURE/ADDITION USE: IM" I <br /> v <br /> ( ome/Cabi ConImercial Business;Bedroom; Deck;etc.) o o <br /> DIRECTIONS FOR PLOT PLANDRAWING: (Aerial or top view) } <br /> 1. Show the location and size c f all existing buildings (EB) and all new buildings (NB) and indicate North (N). <br /> 2. Show the location of the wel (W),septic tank (ST),and drainfield (DF). a <br /> 3. Show dimensions in feet ofth following:(a)building to all lot lines,(b)building to center line of road,(c)building -0 <br /> measurement to the ordinary high water mark of lake,stream,or river. Q <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. 1I a m <br /> �I 2 <br /> PLOT PLAN ° a <br /> 0 P�� d �� °r5 o <br /> Se P Au�,J`z� Y C l <br /> to <br /> fn ,; <br /> 0 <br /> W � <br /> r <br /> m <br /> 0 <br /> O <br /> O <br /> b 1 „ <br /> N 1I{4NIn <br /> r I \ <br /> V \ <br /> 9 <br /> 1 <br /> g o a O m <br /> W —$� 2ao-i fir Q%w <br /> o^ m S.: 2 C8 O <br /> CONDITIONS OF PERMIT: <_ m Z $ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o £ T'z ' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N� M <br /> 3. NO GRADING OR SHORE t ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. U1 : o � - m <br /> g $ ff ' C <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o i <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this applicatio (including any accompanying schedule)and I further declare that I recognize that this infor- <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 nay be a result of the County of Burnett relying on this information I am providing in this ap- <br /> plication.1 agree to permit coun y officials charged with administering county ordinances or other authorized person to have 0" p <br /> access to the above described remises at any reasonable time for the purpose of inspection. T 3 0 R <br /> /� m A N <br /> V <br /> SIGN HERE �� ` '^? <br /> (ai re of ow r building contractor) (dat o x <br /> ZONING ADMINISTRATOR <br /> en hen�' Hen en T <br /> TOWNSHIP PERMITS MAY BE REQUIRED m <br /> 00 0 0 y <br />