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0a. ' <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator5 0 o <br /> APPLICATION FOR — LAND USE — PERMITS _ <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and a <br /> o � <br /> m U <br /> located as shown herein. The undersigned agrees that all work shell 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 _ o <br /> regulations of the State of Wisconsin. m m <br /> m � <br /> I /� c O <br /> OWNER ry �,8rr{ F �1 - TELEPHONE �,f`� _ 7��/ o f <br /> L <br /> ADDRESS3 6 '7 s--Z) 3 S^ C 7 "J V � (�f) <br /> EMERGENCY/FIRE NUMBER Q �. SU ROAD NAME �. C (� C� <br /> LEGAL DESCRIPTION (see tax receipt) .� <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION o <br /> SANITARY PRIVYo <br /> FILLING/GRADING CAMPING UNIT SUBDIVISION o` c <br /> 0 <br /> m <br /> STRUCTURE/ADDITION USE: 57% x.>Z� j o d <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z o <br /> 0 0 <br /> m � <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). <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 -4 <br /> measurement to the ordinary high water mark of lake,stream, or river. c <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. o <br /> Ny <br /> 11 Z v <br /> PLOT PLAN o <br /> w s ' <br /> a <br /> a <br /> �3� <br /> N <br /> 0 <br /> 0 <br /> o <br /> r <br /> M <br /> CONDITIONS OF oPERMIT: o c�p � g ' ; <br /> 1. DRIVEWAY MUST MEET AY�WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. *' <br /> 2. REMOVAL OR CUTi OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. i <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` i '• C <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of 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 informs- <br /> }}��7!� m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this Infor- i i5 75 p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ 8 <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- <br /> plication.I agree to peMaitcounty officials charged with administering county ordinances or other authorized person to have <br /> access to the above-descrited promises at any reasonable time for the purpose of Inspection. T <br /> SIGN HERE ;tpig ure owner or�Ildl p frac d Id al <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS Y BE REQUIRED co g In <br /> m <br /> 888888, rn <br />