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Burnett_ County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 0 <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 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 3 a <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. H m <br /> N � <br /> Q <br /> OWNER /// (l�1 ✓O lK t+ TELEPHONE <br /> UIs JJ g 7 � <br /> ADDRESS Q� ClJdit.�L✓1 -7L �•- l �w'el�� JZ! L <br /> EMERGENCY/FIRE NUMBER L+ %VJ' ROAD NAME r '�! /1.(WG, /l <br /> LEGAL DESCRIPTION (see tax receipt) I <br /> CONTRACTOR S {5 (ill: <br /> TYPE OF PERMIT(S). DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION)— o <br /> n 17 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° i'-'-- <br /> o <br /> llo ' � )/ � / ' S y <br /> STRUCTURE/ADDITION USE: �!Ui/���y, /-Y�sG �"' JV <br /> (Home/Cabin;Comm0 rcial Business; Bedroom; Deck;etc.) Z o <br /> O O <br /> N <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. <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. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a to <br /> 7I Z o <br /> PLOT PLANn p n <br /> S-ee ��'' bio t /��, m CI <br /> c I <br /> �7 <br /> 0 <br /> ° <br /> FIz <br /> Z <br /> f <br /> 2 gi c-m m D O -0 <br /> =KjE m. 9 <br /> CONDITIONS OF PERMIT: <br /> H : z � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m o -{ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. !" O m <br /> ' ' O <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.I acknowledge that I am responsible for the detail and accuracy of all informs- " «�m n : m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 <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- a a (n <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have O 0: <br /> access to the above described premises at any reasonable time for the purpose of inspection. ma 3 $ - <br /> m m n w <br /> SIGN HERE ` `^ <br /> (si atur of owner orb 'Iding contractor) (date) o ? Fr i <br /> , <br /> ZONING ADMINISTRATOR <br /> H NN W N N N N m <br /> TOWNSHIP PERMITS MAY BE REQUIRED o u, o u, v, v, orn <br /> 000000000 <br />