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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator Wl 1 ISvf0 O' <br /> APPLICATION FOR - LAND USE - PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and �2 H <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. m° <br /> N � <br /> 7 C <br /> OWNER •/ ( (r. TELEPHONE �'/Z 9Z J� �G+� 9 0 v O <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBERZ/ /? ROAD NAME <br /> LEGAL DESCRIPTION (see taz receipt)oo'/Vyv,+�y'v " &e�/ •'(�b/✓�y, <br /> .• LceQa 111 pv u v/ / _ <br /> CONTRACTOR O"1 CphS rc,c %,'p\ •— <br /> 1/ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION lam[ o ) <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> r r <br /> STRUCTURE/ADDITION USE: 06 .c- <br /> (Home/Cabin;Commercial Business; Bedro ; Deck; etc.) Z9 <br /> a 0 <br /> 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). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). I o <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)buildingto 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 9 <br /> dated by the owner. o <br /> NOTE', BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSRE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 `0 <br /> c <br /> PLOT PLAN 'rXFSI A P6um;7`4� 4)(0440Sp 83 n o z� <br /> Alt <br /> V <br /> N <br /> ` _. �.. N <br /> i O <br /> I r <br /> I <br /> bn (n VV�nr a 'V <br /> 0 In <br /> M_.. m <br /> CONDITIONS OF PERMIT; u — F�q G.r+'> y ,z C 8 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 0' : - <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. o3 ID <br /> 2 mm <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- om C <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- t w y h: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- ,`� a g p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permi . o`$ o <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 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 p <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> m nA w <br /> SIGN MERE <br /> (signature of owner or building contractor) <br /> o : x: <br /> ZONING ADMINISTRATOR <br /> N. <br /> `� pw�en xsT <br /> TOWNSHIP PERMITS MAY BE REQUIRE 1` O N N N UNOI 8 <br /> ' m <br />