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Burnett County'7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR — LAND USE — PERMITSm 3. <br /> a <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, and with all other applicable County Ordinances and the laws and 3. o. <br /> regulations of the State of Wisconsin. - <br /> m d <br /> OWNER F-I DOnI �JOfl0c)I�j 0 O <br /> TELEPHONE n f <br /> o J <br /> -_ y m <br /> ADDRESS �// �'72 I CHARWE rll'i'M �ONo y �Ji/ 1 - S401� 0 n <br /> EMERGENCY/FIRE NUMBER '1 ROAD NAME 1 <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p �' <br /> V n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> J f- <br /> r <br /> STRUCTURE/ADDITION USE: o ° <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z <br /> 0 0 <br /> 9 <br /> N <br /> 3 <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 drainf laid (DF). <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 M <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a ur <br /> c <br /> PLOT PLAN a <br /> m o <br /> C <br /> m <br /> I <br /> A <br /> I n <br /> O <br /> N <br /> O <br /> J <br /> m <br /> (7 � <br /> N <br /> T/`, I <br /> V Z <br /> M <br /> I I <br /> .0 y <br /> CONDITIONS OF PERMIT. g < <_.: CS 0 5 i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F z1,Q - <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 2N M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. .u�' � gm <br /> C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- : 2i i !a <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- er y a m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B g p <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 may be a result of the County of Burnett relying on this information I am providing in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have O N o <br /> access to the above described premises at any reasonable time for the purpose of inspecbGn,__ <br /> ->� In <br /> i AA <br /> m <br /> SIGN HERE <br /> (signifture of owwef i g co r) t .. <br /> ZONING ADMINISTRATOR <br /> xsa uc+y,e <br /> TOW SHIP PERMITS MAY BE REQUIRE N � � � g Nm <br /> o o o o o <br /> 00 <br />