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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator Ju) l '0- <br /> o £ o <br /> APPLICATION FOR — LAND USE — PERMITS — <br /> d o <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 <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin, y o <br /> w � <br /> c <br /> OWNER ' 1 n1- 1 /_i111'� TELEPHONE o O <br /> Vit L.GI'iri 1yi u � <br /> ADDRESS ���, BEAKO' 'PL eDINA Mw , 5-6410 7� <br /> EMERGENCY/FIRE NUMBER �� 1 �� ROAD NAME 5-7 <br /> LEGAL DESCRIPTION (see tax receipt) UUU <br /> CONTRACTOR <br /> TYPE OF PERMIT ): DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE ADDITION p _ <br /> G) <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> 7 1lidrLA <br /> STRUCTURE/ADDITION USE: SUo � <br /> (Home/Cabin;Commercial Busines ; edroom;Decq;etc.) Z v <br /> o <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 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. Q (� ` <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M J� <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on 3 rn <br /> PLOT PLAN Z <br /> A � n <br /> fn o <br /> C _ <br /> M <br /> I <br /> 0 <br /> N = <br /> O IJV <br /> O y <br /> N <br /> n tel/ <br /> V <br /> Z <br /> s <br /> N (/) 17Nr D DO V <br /> o c <. > j o a F m <br /> CONDITIONS OF PERMIT: < �-, Z C o 0 m' 3 <br /> 1 .DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o y <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. = ^' m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. . . n I <br /> 8 i ii n c <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl o o m <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informs- w m v, 0 <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ a $ <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- N <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have i :l?l 00 . <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> M A w <br /> 8 ' <br /> SIGN HERE ' 1 ' -o <br /> (signs re of owner or buil o rac (date) s <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED N o o m <br /> 989 8888m <br />