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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ( m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> m a <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the A m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 0- <br /> regulations of the State of Wisconsin. <br /> w � <br /> c <br /> O <br /> OWNER J(�mcs vJ �►rnlvS�rJ TELEPHONE <br /> o ' <br /> m m <br /> ADDRESS app GtZRtUtTE ST SC. ?RLLi_ n1N . SS+II <br /> EMERGENCY/FIRE NUMBER 10p �� ROAD NAME Z EiT-CR&uIRG <br /> LEGAL DESCRIPTION (see tax receipt) l <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ✓ ADDITION p <br /> n L1 <br /> SANITARY PRIVY F <br /> ILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: WAT I{GubOECK ° <br /> m <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) z o <br /> 0 0 <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). r <br /> 2. Show the location of the well (W), septic tank (ST), and drainfield (DF). 5i <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building 11 <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 9 <br /> dated by the owner. C o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a N <br /> 11 Z cv <br /> PLOT PLAN ° n <br /> ---. ---- --— — fn <br /> 2`I'-� m <br /> RAW � <br /> L=1ELD i <br /> GARAGE Zq' <br /> OSePT�c <br /> 1 <br /> T n <br /> Z5' <br /> ❑ o <br /> 3a 5' F <br /> WELL <br /> Q ° I�7✓l1 <br /> I m <br /> J <br /> z <br /> ':T Ijay <br /> 1l' Hcxue <br /> f <br /> I , <br /> W m 2. H_m .A <br /> CONDITIONS OF PERMIT: Q $ � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. oZ E o Q E i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. y = XI <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o HO <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. o <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 «r y a i m <br /> tion contained in this application(including any accompanying schedule)and 1 further declare that 1 recognize that this infor- 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 o� o <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 N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. r <br /> m V FFFkkkk w <br /> �^ a <br /> SIGN HERE �.11�I'�O� L1� * m� ; :-c :7 <br /> �S (s, reb wn r builmng contractor) <br /> —---- — <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED m <br /> o <br /> _i�- 0 0 o g o N <br />