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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratorm m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w � - <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. w m <br /> w <br /> C <br /> YNrv�✓p J A/c i SEnI �S3n� E <br /> OWNER TELEPHONE <br /> m <br /> ADDRESS <br /> (' <br /> EMERGENCY/FIRE NUMBER C) C) 0 r) ROAD NAME P-6 N{ A <br /> LEGAL DESCRIPTION (see tau receipt) Sl <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE?Z ADDITION p <br /> � O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> -f- 1 <br /> STRUCTURE/ADDITION USE: S! �' � S-� '��` S1 L`OU v 0 <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). Vin. <br /> 2. Show the location of the well (W),septic tank(ST), and drainfield (DF). a G <br /> 3. Show dimensions Infest 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. C <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 <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I 3 m <br /> PLOT PLAN nn,�Yn�}�� Z c rr� ( r'Y`-fy- 0 <br /> o� U < <br /> M <br /> C ( 0 <br /> y � I <br /> M <br /> /y X -7b <br /> ED <br /> ( <br /> U`) s <br /> i� <br /> o <br /> vF Z <br /> i94a ' <br /> D 0 a r"z0 0 C. m <br /> l>R " 9 = '0agm <br /> CONDITIONS OF PERMIT: ^ Z a. i `� a o 3 0 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p <br /> 0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m0 <br /> g: <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.1 acknowledge that I am responsible for the detail and accuracy of all informs- L ` y:n m <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize that this infor- : 25 it wt ; p <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I goo 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 al$- a+ <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of Inspection. '• ' m Q <br /> T : 38x : <br /> vAs <br /> SIGN MERE 448 <br /> to of own r o b ng n tor) (date) m <br /> a <br /> 22�ti. g r�'i <br /> ZONING ADMINISTRATOF - E - <br /> O N' �_ n <br /> TOWNSHIP PERMITS MAY BE REQUIRED ra' p" o . MM <br />