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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 2 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 5 <br /> located as shown herein, The undersigned agrees that all work shall be done in accordance with the requirements of the '^ <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n ,w1 <br /> /� <br /> o <br /> regulations of the State of Wisconsin. N m <br /> 1NIl�,��1M J&1412 VAZ.N �lMV"* �o�1/ ' ��'`� �d o <br /> OWNER TELEPHONE f <br /> ADDRESS 3 3m <br /> EMERGENCY/FIRE NUMBER ROAD NAME �DIASfiAry '17„vv.-.-, <br /> LEGAL DESCRIPTI 1pee ax seipt) <br /> (�iov fi I--aT Z SJ54TibN J' , <br /> CONTRACTOR J�"V—�[�i 0, LAK (OA45 L�P . <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ^ J` GARAGE/ACCESSORYSSORY STRUCTURE ADDITION o `' r <br /> M 0 <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION <br /> 0 <br /> STRUCTURE/AD ITION USE: <br /> (Home/Cabin;Commercial Business,Bedroo ; Deck;etc.) Z9 <br /> } <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). OQ <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions in feet of thefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building 1A <br /> measurement to the ordinary high water mark of lake,stream, or river. 0 t <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. (j o <br /> NOTE; BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I o N <br /> PLOT PLAN A o a <br /> M o <br /> C l <br /> i <br /> N <br /> m <br /> n <br /> 0 <br /> _ o <br /> N <br /> O I� <br /> 0 — <br /> b <br /> O <br /> fb Ka v / __ <br /> rsr SI� <br /> Old SAaC (0 <br /> �S Zf 5afbw101L 6e <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERM ISSUANCE. c m �Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. F <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �n :"�' In <br /> o nEo: O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl o : m C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs a y m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this mfor- i3' ai <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this apt, x <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to haW, O N p <br /> access to the above described P115plises at any reasonable time for the purpose of inspection. T 3 b0 <br /> m mA ." iG <br /> SIGN HERE <br /> LVI a s <br /> (si uro f owner o b Idinq contractor) (date) <br /> ZONING ADMI RATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED In <br /> ouv v m <br /> bbo o ® Rf <br /> N N N <br /> 0 0 0 0 $ p y <br /> va <br /> F- <br /> 0 <br />