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&` e0y* <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m m o c <br /> APPLICATION FOR - LAND USE - PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v �- <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,y and with all other applicable County Ordinances and the I s and - <br /> regulations of the State of Wisconsin. <br /> 1-7(o f/1 1a r i rbsiaJ3S Jr�l m m <br /> m <br /> a °LJO <br /> OWNER TELEPHONE <br /> F3 <br /> 1/ f I. m m <br /> ADDRESS 2029 P,t !Qe LliL Rd S Oc7[M Q11 (� I 54V66m <br /> EMERGENCY/FIRE NUMBER Zn� ROAD NAME �•Ce Lk RQ <br /> LEGAL DESCRIPTION (see tax receipt) tel"f'� 0 6 / SCC M l0 l.VYA 3 <br /> MIA a IT JPS (l0/ <br /> CONTRACTOR <br /> AL- <br /> TYPE <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE III ADDITION o <br /> n tJ <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o o <br /> 0 <br /> STRUCTURE/ADDITION USE: lc r ° o <br /> (Home/Cabin;eommercial Business;Bedroom;Deck;etc.) Z o <br /> 0 0 <br /> m <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 Nort i (N). r <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). g <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. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE I�SUED. 71 o m <br /> 11 Z `a <br /> PLOT PLAN ° a <br /> m0 <br /> C I <br /> m 0' <br /> b � I <br /> W <br /> mNm <br /> O <br /> O <br /> C I �, <br /> � Om <br /> � y <br /> Z <br /> Z <br /> m <br /> XICONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE, p <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 11 -S2` ' 33 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. (!w rn : t7 m <br /> v <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best o my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- i u m '^; rn <br /> tion contained in this application(including any accompanying schedule)and 1 further declare that I recognize ths t this infor- . $ B p <br /> matlon 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 I am providin 1 In this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized per n to have O o; <br /> access to the above described premises at any reasonable time for the purpose of Inspection. m <br /> n M i <br /> SIGN HERE / r rZ -- C i <br /> w. <br /> (signature of ow or uilding contractor) (date) <br /> ZONING ADMINISTRATOR O In T-- 38 <br /> E g ' <br /> N614" H T <br /> TOWNSHIP PERMITS MAY BE REQUIRED o '(`/ 8 an^nIE3'B m <br /> 888888'88 w <br />